Chemotherapy

Chemotherapy can be used to treat different types of lung cancer, including small cell lung cancer and non-small cell lung cancer. 

Chemotherapy drugs are used to kill cancer cells in your body and are carried by the bloodstream throughout your body. This is sometimes called systemic treatment. 

In this section, we’ll explain:

• How chemotherapy is used to treat small cell lung cancer
• How chemotherapy is used to treat non-small cell lung cancer
• Maintenance chemotherapy
• Receiving chemotherapy
• Potential side effects and how to manage them
• What happens after chemotherapy finishes.

How chemotherapy is used to treat small cell lung cancer

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

Treating small cell lung cancer 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). 

In some circumstances, chemotherapy may be given in combination with atezolizumab, an immunotherapy drug. 

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

• Topotecan, used on its own
• A combination of cyclophosphamide, doxorubicin (Adriamycin®) and vincristine in what is known as the “CAV” regime.

How chemotherapy is used to treat non-small cell lung cancer

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

If you have had surgery for lung cancer and all the cancer cells have been removed, you may still be offered chemotherapy afterwards. This is called adjuvant chemotherapy. 

If you have had surgery and cancer cells remain, your cancer doctor will talk to you about whether you should have chemotherapy and/or radiotherapy. This is called chemoradiotherapy.

If you can’t have surgery, and your type of 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.

The most common chemotherapy treatments for people with non-small cell lung cancer are: 

• Cisplatin
• Carboplatin
• Pemetrexed
• Vinorelbine
• Gemcitabine
• Paclitaxel.

For some people with advanced non-small cell lung cancer, chemotherapy may be used in combination with an immunotherapy drug as their first-line treatment. 

Maintenance chemotherapy

In some circumstances, people receive ongoing chemotherapy. This is called maintenance chemotherapy.

Your cancer doctor may consider you for maintenance chemotherapy if: 

• you have non-squamous non-small cell lung cancer
• your cancer has got smaller or remained stable at the end of your first-line chemotherapy treatment
• you have been coping well with few side effects.

Research has shown that maintenance therapy gives better outcomes for these people, helping to continue to slow down the growth of their lung cancer and keep any symptoms under control for longer.

Receiving chemotherapy

Chemotherapy is usually given as an outpatient in a chemotherapy day unit.

Nearly all chemotherapy for lung cancer is given into a vein (intravenously), usually on the back of your hand or forearm. However, some chemotherapy drugs come in a tablet version and can be taken at home.

Most people receiving chemotherapy intravenously will have a small plastic needle (cannula) placed into the vein and attached to a drip. Some people have chemotherapy give to them through a peripherally inserted central catheter (PICC) line as this can be easier for them than finding a vein each time they go for treatment. The line would be put into a vein in your arm under local anaesthetic.

Chemotherapy treatments can take several hours to be administered. 

Chemotherapy is given in a series of doses followed by rest periods. This is known as chemotherapy cycles. Working in cycles gives your body time in between to recover from any side effects

How often you have each cycle, and how long your chemotherapy treatment lasts altogether, depends on many factors including:

• the type of chemotherapy you have
• why you are receiving chemotherapy
• how the cancer responds to the treatment
• how your body copes with any side effects.

Once the chemotherapy is finished you will be given tablets to take at home to prevent any sickness over the following few days.

Potential side effects and how to manage them

Chemotherapy can conjure up some quite stark images. People often picture losing their hair or feeling very sick.

As with all cancer treatments, chemotherapy can cause side effects. However, in most cases, these are manageable and ease with time. 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.

Common side effects include:

• Feeling nauseous or being sick
• Extreme tiredness
• Hair thinning and hair loss
• Fever and low white blood count
• Mouth sores

Managing side effects

Feeling nauseous 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.

Some people find ginger can help reduce nausea caused by chemotherapy. This includes drinking ginger tea or ginger ale, eating ginger sweets or even placing slice of fresh ginger under your tongue.

Extreme tiredness

Fatigue is a very common symptom of chemotherapy and it is important to rest after receiving treatment. However a small amount of regular exercise will also help reduce your tiredness. Try going out for a gentle walk, doing a few minutes of stretches or pottering in the garden.

Hair thinning and hair loss

Chemotherapy is likely to affect your hair to some extent. Some drugs, such as etoposide, paclitaxel and docetaxel can cause total hair loss. Although this can be distressing, it is temporary.

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

You are at higher risk than normal of getting an infection when you are having chemotherapy because your immune system is affected by the treatment. Therefore, it’s important to stay away from anyone who you know has an obvious infection, such as the flu, chickenpox or shingles. You may also choose to wear a face mask when to places where there are lots of people. 

Mouth sores

It is not uncommon for people to get a sore mouth, including mouth ulcers, when having chemotherapy. 

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. 

Drinking pineapple juice can also ease the pain of mouth ulcers.

If you have white patches over the lining of your mouth or your tongue you may have a fungal mouth infection called thrush. This is quite common, and you should speak to your GP or hospital who will prescribe an anti-fungal medicine to treat it. 

What happens after chemotherapy finishes

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.