About chemotherapy for lung cancer

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1 About chemotherapy for lung cancer This information is about chemotherapy for lung cancer. There are sections on What is chemotherapy? Chemotherapy for small cell lung cancer Chemotherapy for non-small cell lung cancer How you have your treatment How many treatments you are likely to have Taking nutritional supplements or herbal treatments with chemotherapy Getting more information What is chemotherapy? Chemotherapy means using anti cancer or 'cytotoxic' drugs to destroy cancer cells. These work by disrupting the growth of cancer cells. As they circulate in the blood, they can reach cancer cells wherever they are in your body. Chemotherapy for small cell lung cancer Chemotherapy is the main treatment for small cell lung cancer. Doctors choose it because This type of cancer responds very well to chemotherapy Small cell lung cancer tends to have microscopic spread when it is diagnosed Radiotherapy and surgery are both local treatments. Chemotherapy treats the whole body. So if any cells have broken away from the primary cancer by the time it is diagnosed, they could be anywhere in the body. The cancer cells are so small they cannot be seen on scans. This 'microscopic spread' often happens early on with small cell lung cancer. So doctors will often assume that there is microscopic spread, even though scans may be clear. So, you are most likely to have chemotherapy for this type of cancer. Often it is used on its own. Or you may have chemotherapy before radiotherapy (or at the same time). If surgery is possible for very early small cell lung cancer, your doctor may suggest chemotherapy with or after surgery. This is because there are likely to be cells that have broken away from the tumour and travelled to another part of the body, even in very early small cell cancer. 1

2 The commonest used chemotherapy combination for small cell is cisplatin and etoposide. Small cell lung cancer usually responds well to this, but researchers continue to test other combinations to see if they can either improve the results, lessen the side effects or hopefully, both. Carboplatin may be used instead of cisplatin; and other combinations which may be used include CAV (cyclophosphamide, doxorubicin and vincristine), and for relapsed disease ACE (doxorubicin, cyclophosphamide and etoposide). In Wales, the AWMSG (All Wales Medicines Strategy Group) has recommended topotecan chemotherapy for people whose small cell lung cancer has come back after treatment, but only if they are not able to have doxorubicin. This will usually be because they have pre-existing heart problems, and doxorubicin can cause damage to the heart. Chemotherapy for non small cell lung cancer Non small cell lung cancer is not as sensitive to chemotherapy as small cell lung cancer. And there is less likely to be microscopic spread if it is diagnosed at an early stage. So surgery or radiotherapy (or both) are the main treatments. But chemotherapy can still be valuable and is becoming more frequently used. You may have chemotherapy After surgery to lower the risk of the cancer coming back Before or after radiotherapy treatment To help control symptoms of the cancer Your doctor might suggest chemotherapy after surgery to help lower the risk of the cancer returning. It is important that your doctor talks to you beforehand about the benefits and side effects of chemotherapy. If you are fit enough to have chemotherapy you usually start it within about 6 weeks of having surgery. A 2000 Cochrane review found that giving chemotherapy after radiotherapy helped people with non small cell lung cancer live longer. 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 your cancer. The 2000 Cochrane review also showed that chemotherapy helped people with advanced non small cell lung cancer to live longer, even if they were not likely to be cured of their cancer. 2

3 In June 2001, the National Institute for Clinical Excellence (NICE) recommended that chemotherapy should be considered for people with non small cell lung cancer who were not likely to be cured of their cancer. They say that chemotherapy with either gemcitabine, paclitaxel (Taxol) or vinorelbine, together with a platinum drug (for example carboplatin or cisplatin) should be the first choice for people with advanced non-small cell lung cancer (stages 3 and 4), as these are likely to be the most effective drugs. If you have had chemotherapy before and the cancer has continued to grow or spread, they recommend treatment with docetaxel (Taxotere). Your doctor will talk to you carefully about the possible risks and benefits of further treatment. Not everyone is suitable for it. It will depend on how fit you are, and how able you are to cope with side effects of more chemotherapy. Chemotherapy before surgery is called 'neoadjuvant therapy'. Doctors are investigating this in clinical trials. They are trying to find out if treating lung cancer in this way improves the long term success rate. This is not a standard treatment at the moment and you are only likely to be offered neoadjuvant therapy as part of a clinical trial. How do you have chemotherapy? You have to have most chemotherapy drugs by injection into a vein or through a drip. But there are some that come as tablets you take by mouth. How you have the drugs - and how often - depends on which drugs your doctor is treating you with. 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, each chemotherapy treatment is given over a few days. Then you have a rest period of 3 or 4 weeks. This allows 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 the cancer is responding How your body is coping with the side effects You can have most chemotherapy drugs as an out patient. So you come in for treatment and go home afterwards. Your chemotherapy nurse will give you medicines for side effects to take home in case you need them. 3

4 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. How many treatments? Most chemotherapy is given for 4-6 treatments. So a full course can take 3 to 4 months. If you are having treatment for symptoms, it is most important that you don't continue with treatment that is not helping your symptoms. The aim of the treatment is to help you feel better. There is no point causing you to have treatment side effects if the cancer is not responding to the chemotherapy drugs. 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. It may be very upsetting to be told your treatment is being stopped after only 2 treatments when you thought you'd have 6. But your specialist really does have your best interests at heart and will not suggest stopping unless there is no sign of the treatment working. Taking supplements with chemotherapy There is increasing concern amongst doctors about dietary supplements and herbal medications. We don't know what people with cancer are buying over the counter or getting from alternative and complementary therapy practitioners. There's nothing wrong with trying to help yourself get better, of course. But we don't know enough scientifically about how some supplements may interact with chemo. You should talk to your specialist about any other tablets or medicines you take whilse you are on active treatment. It may not be a good idea to take anything that claims to boost your immune system, for instance. Doctors are already telling people with lymphomas or leukaemias that they should avoid these. We just don't know how supplements may interact with treatment for other types of cancer yet. For more information about lung cancer, visit our website You can find a wide range of detailed, up to date information for people affected by cancer, including a clinical trials database that you can search for trials in cancer care in the UK. For answers to your questions about cancer call our Cancer Information Nurses on , 9am till 5pm Monday to Friday 4

5 Adapted from Cancer Research UK s Patient Information Website CancerHelp UK in May 2008 CancerHelp UK is not designed to provide medical advice or professional services and is intended to be for educational use only. The information provided through CancerHelp UK and our nurse team is not a substitute for professional care and should not be used for diagnosing or treating a health problem or disease. If you have, or suspect you may have, a health problem you should consult your doctor. Copyright Cancer Research UK 2008 Cancer Research UK Charity Number