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Chemotherapy

Chemotherapy is a general term for the treatment of cancer using drugs. Patients with different types of lung cancer are likely to receive different combinations of chemotherapy drugs. After discussing treatment options with patients, doctors will decide which chemotherapy drugs are most suitable.

Chemotherapy can be used to treat lung cancer in several ways:

  • Aim to cure early stage or locally advanced inoperable lung cancer in combination with radiotherapy (chemoradiotherapy)
  • Attempt to shrink the tumour before surgery or radiotherapy (neo-adjuvant chemotherapy)
  • Extend length of life when a cure is not possible (palliative chemotherapy)
  • Remove any undetectable cancer cells that may still exist after successful surgery for lung cancer, or to help prevent recurrence (adjuvant chemotherapy)
  • Reduce symptoms, such as breathlessness (palliative chemotherapy)

Chemotherapy for small cell lung cancer

If you have small cell lung cancer (SCLC), chemotherapy is usually the first type of treatment you receive. This is because SCLC can grow and spread quickly, and has often spread outside the lung when the lung cancer is detected, and responds well to chemotherapy.

Treating it systemically with chemotherapy usually leads to relief of symptoms and longer survival. Radiotherapy may be given after chemotherapy to try to stop the cancer coming back.

There are a variety of different types of chemotherapy drugs for small cell lung cancer. The most common first line treatment is a combination of etoposide and one containing platinum (cisplatin or carboplatin).

Other drugs that may be used as further treatment (second or third line) after initial chemotherapy, include:

  • Topotecan
  • Cyclophosphamide
  • Doxorubicin
  • Vincristine .

The fi rst drug, topotecan, is used on its own, and the other three are used together in what is known as the “CAV regime”.

If you have small cell lung cancer, our free booklet Understanding you small cell lung cancer can provide you further information about your condition and the possible treatment options.

Chemotherapy for non-small cell lung cancer

Chemotherapy can also be used to treat non-small cell lung cancer (NSCLC). It may be used as the only treatment, as a treatment before or after surgery, or to manage symptoms of advanced lung cancer.

Nicola share her experience of chemotherapy

If lung cancer surgery is not suitable for you, and your type of lung cancer means that a targeted therapy or immunotherapy drug is likely to be less effective, you may be offered either chemotherapy on its own or in combination with radiotherapy (if you are fit enough).

If you have had surgery for lung cancer and all the cancer cells have been removed, you may still be offered chemotherapy afterwards (adjuvant chemotherapy). However, if you have had surgery and cancer cells remain, your cancer doctor will talk to you about whether you should have radiotherapy and/or chemotherapy (chemoradiotherapy).

There are various types of chemotherapy drugs used to treat NSCLC, and doctors will use different ones to treat the various sub-types mentioned on page 5. The most commonly used chemotherapy for people with NSCLC contains platinum (cisplatin or carboplatin) with one of the following drugs:

  • Pemetrexed
  • Vinorelbine
  • Gemcitabine
  • Paclitaxel.

Your cancer doctor may use a variety of chemotherapy drugs to treat your lung cancer either as a first treatment after diagnosis or if it comes back (called a relapse). Second or third line treatments may be different chemotherapy drugs, targeted therapies or immunotherapy drugs.

Common questions

Some types of chemotherapy can be given at an out-patient clinic, others require a short stay in hospital.

Before receiving chemotherapy, doctors make sure the patient does not have a higher than normal risk of developing side effects. A blood test will be taken to ensure that the patient’s blood, kidneys and liver are working normally.

Most chemotherapy for lung cancer is given into a vein (intravenously) usually on the back of the hand or forearm. A small plastic needle (called a cannula) is put into the vein and attached to a drip.

Patients will be given anti-sickness medicines into the drip before starting the chemotherapy. Tablets are also given to patients to take home after treatment to prevent any initial sickness. A few types of chemotherapy are available in tablet form which still requires a visit to the out-patient clinic.

Generally, the time in between each treatment is three to four weeks which allows the body to recover before receiving more chemotherapy drugs. Doctors will assess patients’ side effects after each treatment, making adjustments to the next treatment as required.

It is not unusual to be frightened of needles and nursing staff have many ways of reducing your fears. Tell your nurse if you are feeling nervous before you begin your treatment as there are creams available to numb your skin.

Some people feel sick at the thought of treatment or from the smell of hospitals. This is called anticipatory nausea and vomiting which can be helped with a variety of relaxing techniques. These include counselling and medication and your options can be discussed with your treatment team.

All forms of cancer treatment have side effects of one sort or another. Most people have some side effects from having chemotherapy. However, in most cases, these are manageable and ease with time.

Common side effects include:

  • Feeling or being sick: There are very powerful anti-sickness drugs that can help reduce sickness in most patients. Remember to take the tablets for sickness that the hospital has given you. If they don’t work, let your cancer doctor know, as there is usually an alternative.
  • Extreme tiredness: Although it is important to rest, a small amount of regular exercise will also help reduce your tiredness. If you feel breathless, your legs ache or you are concerned that you feel too tired, ask your GP or hospital team for advice.
  • Hair loss: We understand this can be very distressing. However, it is temporary and does not happen with all chemotherapy drugs. If you notice your hair starting to fall out, try wearing a hairnet at night and a hat/scarf during the day. Don’t brush your hair too much or use hair colourants/ rollers. Most hospitals will be able to give you advice on how to get a good quality wig and which scarves work best.
  • Fever and low white blood count: It is important to realise that you are at higher risk than normal of getting an infection which your body can’t fight on its own because your immune system is affected by the treatment. Therefore, if anyone you know has an obvious infection, such as the flu, chickenpox or shingles, it is best to stay away.
  • Mouth ulcers: Having good oral hygiene is important. Keep your mouth clean and fresh, regularly brushing your teeth or dentures with a soft toothbrush. It may be a good idea to visit your dentist for a check-up before your treatment starts. Many people find drinking pineapple juice can ease the pain.
lung cancer treatment diary
Keeping track of your progress can help

I kept a diary between chemo sessions. It gave me great comfort during treatment to read back about the previous session and how things got better.

Val, living with lung cancer

It is important to talk through any side effects with your cancer doctor or lung cancer nurse specialist as they will be able to help

Yes, although they may last longer or start later in some patients. Sickness usually comes within the first week after treatment.

White blood cells and platelets reach their lowest point 10-15 days after treatment and often the only sign of this is feeling tired when even the smallest task feels like a great chore. This is also the time when patients are at the most risk of picking up infections.

Generally, side effects tend to reduce by the third week after chemotherapy and patients should start to feel better at this point in time for their next treatment. However, some side-effects including tiredness, bad taste in the mouth and tingling in the fingers and toes may continue for some time after treatment.

It is quite common for people to lose their appetite while having chemotherapy. Your sense of taste may also be affected, such as having a metallic taste in the mouth or no taste at all. If you are concerned you are not eating or drinking enough, you should tell your doctor as there are dietary supplements available on prescription.

The third day after chemo I felt better and wanted something to eat. I didn’t do too much and gradually got back to how I felt before.

Kenny, living with lung cancer

Tips to help make food taste better

  • Try new foods that you haven’t tried before
  • Use herbs and seasoning to add flavour to food
  • Marinating food before cooking may help to improve flavour
  • Sharp tasting foods such as fruit juices, pineapple and grapefruit will leave a refreshing taste in your mouth
  • Cold food sometimes tastes better than hot food
  • Eat small meals and snacks regularly throughout the day, rather than large ones only at meal times
  • Avoid drinking too much liquid before eating as this will fill you up.

While it can be difficult to measure exactly how well it is working, usually an assessment will be made during treatment after approximately two-three courses of chemotherapy. Usually this will be done by chest x-ray and/or CT scan.

An improvement in symptoms can also suggest that the treatment is working; for example, reduced coughing or breathlessness. If there is evidence that the cancer is responding to the chemotherapy then treatment will continue, as long as the patient is not having intolerable side effects.

As it turned out, after three cycles of chemo the main tumour in my lung had gone from the size of a grapefruit to the size of a grape and I realised the chemo was obviously doing its job.

Craig, living with lung cancer

It is important to know of any evidence that the cancer is not responding so that a decision about alternative treatment can be made. Sometimes there may be no change in the state of a tumour when the x-ray scan has been done.

This may seem disappointing but is a worthwhile response, especially if the patient is feeling better. Even if the chemotherapy has not changed the size of the tumour, it may well have delayed the growth of it.

If there is evidence that your cancer is not responding to the treatment, or you are not coping well with it, then your healthcare team will consider stopping the treatment and talk to you about further options that may be available to you. This may or may not be a different chemotherapy drug.

Before deciding to go ahead with any further chemotherapy, ask your doctor about any risks, benefits and side effects you might expect. They will also be able to tell you about the aim of any suggested treatment, how effective it is likely to be, and your chance of getting better.

Some people are able to cope with and respond to several courses of chemotherapy, but others can find it hard going. You will need to base your decision on your own experience of treatment so far, and what your doctor says.

At any point during your treatment, you can ask your cancer doctor about any clinical trials that may be available to you. Getting into a trial is often based on being able to meet some very specific criteria. Your cancer doctor will be able to tell you if you are eligible.

Once you have finished treatment you may be anxious that you are no longer attending the chemotherapy department. You may have been going for a number of months and suddenly your routine has changed. This can make you feel a bit worried and low, and this is normal. However, over time, these feelings should ease.

After your chemotherapy has finished, you may have a scan to find out how your cancer has responded to the treatment. Your cancer doctor will then speak to you about the results and whether or not you would benefit from further treatment. If your cancer has responded well to the treatment, you may not need more treatment straight away.

You will then have regular check-ups with your oncology team to make sure your cancer hasn’t become active again. This may include blood tests, scans or X-rays. If you have any problems or notice new symptoms in between your appointments, let your cancer doctor know as soon as possible.

In general, cancer patients will have these regular checks until they show no evidence of new disease (or relapse) for five years, at which point they will be discharged from their cancer doctor’s care. If they show the cancer has come back, the process of deciding on the best course of action will start, exploring treatment options or best supportive care.

If you have any problems or worries in between your appointments, contact your lung cancer nurse specialist. You don’t have to wait until your next clinic appointment.