About chemotherapy for lung cancer

Chemotherapy means using anti cancer (cytotoxic) drugs to destroy cancer cells. These work by disrupting the growth of cancer cells. Chemotherapy drugs circulate in the bloodstream around the body.

Chemotherapy is the main treatment for small cell lung cancer. Doctors use it because

• This type of cancer responds very well to chemotherapy
• Small cell lung cancer tends to have spread beyond the lung when it is diagnosed

Chemotherapy drugs circulate in the bloodstream around the body. So it can treat cells that have broken away from the lung tumour and spread to other parts of the body even if they are too small to see on scans. This microscopic spread often happens even in the early stages of small cell lung cancer.

Often chemotherapy is used on its own. Or you may have chemotherapy before radiotherapy (or at the same time). If you are to have surgery for very early small cell lung cancer, your doctor may suggest that you have chemotherapy before or after surgery.

Commonly used chemotherapy drugs for small cell lung cancer include

• EP – cisplatin and etoposide
• Carboplatin and etoposide
• CAV (cyclophosphamide, doxorubicin and vincristine)
• CAVE (CAV plus etoposide)
• GemCarbo (gemcitabine and carboplatin)
• Topotecan (Hycamtin)

Small cell lung cancer usually responds well to these treatments, but researchers are continuing to test other combinations to see if they can either improve the results, lessen the side effects, or both.

For cancer that has come back after treatment, ACE chemotherapy is commonly used (doxorubicin, cyclophosphamide and etoposide) or CAV chemotherapy (cyclophosphamide, doxorubicin and vincristine). Topotecan chemotherapy is used for people who have a heart condition and cannot have doxorubicin. Doxorubicin can cause damage to the heart.

There is information about current chemotherapy research in the lung cancer research page in this section. And you can find out about clinical trials on our clinical trials database. Choose 'lung' from the dropdown menu of cancer types.

Chemotherapy can be used to treat non small cell lung cancer in the following situations

• Before or after surgery, to lower the risk of the cancer coming back
• Before, after, or alongside radiotherapy treatment to get rid of the cancer
• To control symptoms and try to help people live longer

Combinations of chemotherapy tend to work better than single drugs. Usually cisplatin or carboplatin (Paraplatin) are combined with at least one other drug such as

• Vinorelbine
• Gemcitabine
• Paclitaxel (Taxol)
• Docetaxel (Taxotere)
• Doxorubicin
• Etoposide
• Pemetrexed

Other drugs that may be used include 

• Ifosfamide
• Mitomycin
• Topotecan

Chemotherapy before surgery is called neoadjuvant therapy. A review of research trials in 2007 found that this type of treatment helped some people with non small cell lung cancer to live longer. More research is needed to find out which patients will benefit most. You can read this review of neoadjuvant chemotherapy for non small cell lung cancer in the Cochrane Library. It was written for researchers and specialists so is not in plain English.

After surgery your doctor might suggest chemotherapy to help lower the risk of the cancer coming back. It is important that your doctor talks to you beforehand about the benefits and possible risks of chemotherapy because the drugs can cause side effects. Chemotherapy tends to work best in patients who are fit. If you are fit enough to have chemotherapy you usually start it within about 8 weeks of having surgery.

Some studies have found that giving radiotherapy after chemotherapy helps people with advanced non small cell lung cancer to live longer even if they are not likely to be cured of their cancer. If you have advanced non small cell lung cancer, your doctor may suggest combined treatment with radiotherapy and chemotherapy as the best way of trying to control it. 

In June 2010 the National Institute for health and Clinical Excellence (NICE) issued guidance saying that maintenance pemetrexed should be a treatment option for people whose cancer has not immediately come back after combination chemotherapy treatment with cisplatin and either gemcitabine, docetaxel or paclitaxel. Maintenance treatment means that you keep having the treatment until the disease comes back up to a maximum of 18 cycles of treatment. They add that it should not be an option for people who have already had pemetrexed as a first line treatment in combination with cisplatin. The Scottish Medicines Consortium (SMC) in October 2010 did not recommend maintenance pemetrexed for use in the NHS in Scotland because they say it is not cost effective.

If you have had chemotherapy before and the cancer has continued to grow or spread, NICE recommend treatment with docetaxel (Taxotere) alone. Biological therapy drugs such as erlotinib (Tarceva) or gefitinib (Iressa) are sometimes used instead of docetaxel. Your doctor will talk to you in detail about the possible risks and benefits of further treatment. These treatments will not help everybody. It will depend on how fit you are, and how able you are to cope with side effects of treatment.

You have most chemotherapy drugs by injection into a vein or through a drip. But some are tablets or capsules that you swallow.

How you have the drugs, and how often, depends on which drugs you are having. Usually, you have treatment with a combination of 2 or 3 different chemotherapy drugs together. You will need to ask your chemotherapy nurse or doctor to explain the details of your treatment to you.

Most often, you have the chemotherapy treatment every 3 to 4 weeks. Then you have a rest period to allow your body to get over any side effects. The number of treatments you have depends on

• Which drugs you are having
• The type of cancer you have
• How well the treatment is working
• How your body is coping with the side effects

You can have most chemotherapy drugs as an outpatient. So you go into the hospital or clinic for the day to have treatment and go home afterwards. Your chemotherapy nurse will give you medicines to take home in case you need them to control side effects.

Some chemotherapy drugs have to be given in hospital. Usually this is because you have to have them through a drip over a number of hours. So depending on your treatment, you may have to stay overnight, or for a few days.

Most chemotherapy is given for 4 to 6 treatments. So a full course can take 3 to 6 months.

If you are having treatment to control symptoms, the aim of the treatment is to help you feel better. Your doctor will keep an eye on your progress by monitoring your symptoms and possibly by checking the size of your cancer on scans and X-rays. If the treatment is working well you will continue with the treatment. If the treatment is not working well your doctor will suggest changing to a different treatment or stopping it. It may be very upsetting to be told that your treatment is being stopped after only 2 treatments when you thought you would have more. But you can talk to your doctor or specialist nurse about the other treatment options in this situation.

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed them by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section of CancerHelp UK.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

You can look at the main chemotherapy section in CancerHelp UK. It gives detailed information about

• What chemotherapy involves
• How chemotherapy is planned
• General chemotherapy side effects
• Living with chemotherapy

You can ask your doctor or chemotherapy nurse to write down the names of the drugs you will have so you can look them up in our specific drug side effects section. There are pages there for all the most commonly used chemotherapy drugs. Each drug page has information about common, occasional, and rare side effects for that drug.

Our lung cancer organisations page gives details of people who can give information about lung cancer chemotherapy. Some organisations can put you in touch with a cancer support group. Our lung cancer reading list has information about books and leaflets on lung cancer treatments.