Lung Cancer Treatment Options


A lung cancer diagnosis can be scary. But the good news is death rates for the most common type, non-small-cell lung cancer (NSCLC), has dropped significantly over the last 15 years.

“Within just the last 7 years, there have been so many approvals of new treatments for lung cancer that it’s made a huge difference for many patients and their survival,” says Anne Tsao, MD. She’s a lung cancer specialist at the University of Texas MD Anderson Cancer Center in Houston. “Just a decade ago, there was a lot of pessimism among lung cancer specialists. Today, there’s mainly hope.”

Treatments for Non-Small-Cell Lung Cancer (NSCLC)

Up to 90% of all lung cancers are non-small-cell lung cancer (NSCLC). Here’s a look at treatments, from traditional to groundbreaking.


This is the traditional gold standard treatment for people with early (stage I or stage II) NSCLC. There are three main types:

Lobectomy. This is when your surgeon removes the lobe, or section, of your lung with the tumor. Your lungs have five lobes: three on the right and two on the left. This is usually the preferred type of surgery for NSCLC, Tsao says.

Segmentectomy or wedge resection. These surgeries only removes part of a lobe. “We use this approach if someone doesn’t have strong enough lung function to remove the entire lobe,” Tsao says.

Pneumonectomy. This surgery removes the entire affected lung. You may need this if your tumor is very close to the center of your chest.

If you have a stage III tumor, your doctor might also recommend surgery after you’ve had both chemotherapy and radiation to shrink the tumor.

Radiation and chemotherapy

Radiation uses high-energy beams to kill cancer cells. Chemotherapy uses drugs to slow or stop the growth of cancer cells. Your doctor may recommend one or both if:

  • You have stage I or II NSCLC and the surgeon couldn’t remove all of the tumor
  • You can’t get surgery because of another health condition or some other reason
  • You have stage III NSCLC

If you do need chemo, your doctor will usually use a combination of two drugs. One of the most common ones is the drug cisplatin. It works very well, but it has a higher risk of side effects like nausea, vomiting, and a low white blood cell count.

Targeted therapies

Tsao says one of the biggest breakthroughs in NSCLC treatment is the ability to do genetic testing on your tumor. Your doctor can then look for specific mutations, or changes, in the tumor’s DNA. If your cancer has any of these mutations, then there are specific, targeted therapies for them. For example, if you have an EGFR mutation, it means that you have too much EGFR protein on the surface of your cancer cells, which helps them grow faster. Drugs like erlotinib (Tarceva) or afatinib (Gilotrif), block the signal from EGFR that tells these cells to grow.

Unlike chemo, which requires an IV, many of these treatments can be taken every day at home as a pill. And they often cause fewer side effects because they only target specific areas on cancer cells instead of healthy cells, too. Targeted therapies have primarily been used to treat stage IV cancer, but doctors are beginning to use them earlier in treatment. A study published last year in The New England Journal of Medicine looked at patients with early-stage EGFR mutation cancer who were given the targeted therapy osimertinib (Tagrisso) once a day for 3 years. Researchers found it lowered the risk of death or cancer coming back by 83% compared to a placebo group.


If your tumor doesn’t have a mutation that makes you a good fit for targeted therapy, then this form of treatment may help. It uses your body’s immune system to slow down cancer growth. When you get genetic testing, doctors also look for how much of a protein called PD-L1 is present in your cancer.

“This protein acts like the brakes of a car on your immune system: It acts as a checkpoint to prevent it from going into overdrive,” Tsao says. “But cancer cells are clever and try to use this pathway to sneak past your immune system.”

If your cancer has a lot of PD-L1, then certain drugs that stop it, like nivolumab (Opdivo), pembrolizumab (Keytruda), and cemiplimab (Libtayo) may be good options.

Like targeted therapies, these drugs were all initially approved for stage IV lung cancer. But there’s research that suggests they may work earlier. One study found that the drug atezolizumab (Tecentriq), when given after chemotherapy to patients in remission with stage II or early stage III NSCLC, had significantly improved survival rates compared to patients who got a placebo.

Treatments for Small-Cell Lung Cancer (SCLC)

If your cancer is caught early and is very small, you may be a good fit for surgery, followed by chemotherapy and radiation.

But very few patients with SCLC are, Tsao says. Most of the time, the standard treatment is chemo and chest radiation, known as chemoradiation. If you do both at the same time, you may live longer, but there are more side effects than doing one alone.

About half the time, the cancer will spread to the brain. Your doctor may give you radiation therapy to the head to try to avoid this.

Research is ongoing and experts are studying more ways to treat SCLC.

“We’ve learned that there are four different genetic small-cell lung cancers, and the hope is each type will benefit from more targeted therapies,” Tsao says.

One such drug, lurbinectedin (Zepzelca), has shown promising results and is being studied with the chemotherapy agent doxorubicin in a larger trial.

The most important thing when it comes to lung cancer is to try to get treated, at least initially, at an academic medical center.

“It’s easier for academic centers to do the genetic sequencing for these types of tumors, but smaller, community-based hospitals may not have the same resources,” Tsao says. “But treatment based on tumor type has proven to be a game changer as far as lung cancer survival rates. We can’t cure lung cancer, but with the latest therapies and technologies, much of the time it can become a manageable disease.”