When it comes to lung cancer treatment, your doctor will base it mainly on the stage and tumor type. But other factors, like your overall health and any preexisting medical conditions, are also important. Here’s what you need to know.
Stage of Cancer
The most common type of lung cancer is non-small-cell lung cancer (NSCLC). If you have early-stage NSCLC (generally stage 0 or I), the only treatment you’ll need is surgery — most of the time. But the more advanced your
cancer is, the more treatments it will require. For example, if you have stage II cancer, your doctor will usually recommend chemotherapy after surgery. If it’s stage III, they’ll likely suggest both chemotherapy and radiation after surgery.
If your cancer is very advanced — stage IVB — then doctors will check your tumor for mutations, or certain changes, before deciding which treatment is best.
“Both genetic and immune therapy biomarkers are important,” says Alexander Drilon, MD, a lung cancer specialist at Memorial Sloan Kettering Cancer Center in New York City.
Genetic markers include mutations in these genes:
- KRAS
- EGFR
- ALK
- ROS1
- BRAF
- RET
- MET
- NTRK
If your doctor spots any, your first treatment will probably be a targeted therapy drug. The doctor will also check for a protein known as PD-L1, which is found on both your body’s immune cells as well as cancerous ones. If your tumor has high amounts of PD-L1, you’re considered a good candidate for immunotherapy treatment such as nivolumab (Opdivo) or pembrolizumab (Keytruda).
Small-cell lung cancer (SCLC) grows fast. Most people with SCLC have cancer that has already spread at the time of diagnosis. The best treatments are radiation and chemotherapy. If your cancer is very far advanced, your doctor may recommend the immunotherapy drugs atezolizumab (Tecentriq) or durvalumab (Imfinzi), along with the chemotherapy drugs etoposide and carboplatin.
Your Health Status
Health issues that could impact how doctors decide to treat your cancer include:
High blood pressure. Anti-VEGF medications like bevacizumab (Avastin) help block a protein called VEGF. This helps block the blood flow supply to tumors and shrinks your cancer. But these medications can affect other blood vessels, which can lead to high blood pressure. In these cases, it’s important to get your blood pressure under control before you start treatment, Drilon says.
Autoimmune disorders. Immunotherapy boosts your immune system’s ability to detect and kill cancer cells. While this works well, experts think it might cause trouble for people with autoimmune diseases like inflammatory bowel disease (IBD), multiple sclerosis, or rheumatoid arthritis. It could cause their immune system to go into overdrive and attack healthy tissues.
“In these situations, we would want to be much more cautious about immunotherapy,” Drilon explains. “If it’s severe then we shy away from it unfortunately. For those with a history of low-moderate conditions that were well-managed and not known to be active, it’s often a discussion of the pros and cons with patients.”
Kidney or liver disease. Most drugs are broken down in your liver and let out through your kidneys. This is why it’s so important that your doctor order blood tests to assess kidney and lung function before you start treatment, Drilon says.
“These tests help determine if your body’s organs are healthy enough to process the treatments,” he explains.
If you do have preexisting kidney or liver damage, you may need a different dose. Your doctor might want you to come in regularly for tests to keep an eye on these organs.
Age. A 2018 study found that more than 60% of people over the age of 80 with stage III lung cancer did not get any sort of treatment. Other research suggests that older adults with lung cancer have the same outlook as younger ones.
“I personally would not deprive an older, fit patient of treatment just because she or he is above a certain age,” Drilon says. “We don’t just look at age as a number: We do a general assessment of how well the patient is, despite their numeric age.”
This is especially true for newer lung cancer therapies such as immunotherapies, which tend to have fewer side effects than traditional chemotherapy.
Smoking. Some people with lung cancer keep smoking after diagnosis. But this can lead to lung damage that impacts their ability to handle treatment, Drilon says. One study found that people who did reported more intense lung cancer symptoms, including:
- Higher levels of pain
- Fatigue
- Shortness of breath
- Trouble eating
Smoking may also change the way your body processes chemotherapy drugs making them less effective. It also raises the risk of your cancer coming back or that you’ll get a second, unrelated lung cancer.