Lung Cancer Treatment

FDA-Approved Treatments for Lung Cancer

Lung cancer is the third most common type of cancer diagnosed each year in the United States. The only two diseases with more cases are prostate cancer and ovarian cancer.

Due to the high rates of lung cancer among U.S. residents, the Food and Drug Administration (FDA) regularly reviews potential therapies for official approval. The first chemotherapy drug was approved for lung cancer in the 1940s. The number has grown significantly since the beginning of the 21st century.

What Are the FDA-Approved Treatments for Lung Cancer?

According to the National Cancer Institute, there are now nearly 40 different therapies approved for lung cancer. These treatments are discussed and tailored to each patient’s individual needs..

Lung cancer therapies include chemotherapy, immunotherapy and targeted therapy. Some of them are approved for both small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). A few are approved for only NSCLC, which spreads slower, is easier to treat, and has better lung cancer survival rates.

Which Treatments Are Approved for Non-Small Cell Lung Cancer?

There are many approved therapies for NSCLC. They’re listed below. The generic name is listed in parenthesis when the brand name is provided. If no brand name is provided, the generic name is listed alone:

Which Treatments Are Approved for Small-Cell Lung Cancer?

There are nearly a dozen therapies approved for SCLC. They are listed below. If a brand name is provided, that is listed first with the generic name in parenthesis. If no brand name is provided, then the therapy is listed by its generic name:

What Are the Main Types of Lung Cancer Treatment?

Each type of lung cancer treatment is developed to kill tumors in a different way. For instance, chemotherapy drugs kill all cells in its path, wiping out cancer cells but also possibly damaging your healthy tissue. Surgery allows doctors to remove all or most of the tumor by removing a portion of your healthy tissue or an entire organ surrounding the cancerous mass.

Doctors recommend each treatment depending on the type of lung cancer and the size of the tumor.

There are five main types of lung cancer treatment:

Surgery for Lung Cancer

Surgery is the most invasive type of treatment for lung cancer, but it also carries the best chances for lengthy survival and even a cure. Many patients ask their primary physician or specialist if surgery is an option for their case. The answer depends on the patient’s age, physical fitness and overall health status, type of lung cancer, and the stage of their cancer.

Surgery is most often used for non-small cell lung cancer, which grows slower than small-cell-lung cancer. The speed of tumor growth for small-cell lung cancer eliminates most surgical options since partial removal of the lung won’t eliminate the entire disease.

An estimated 25% of non–small cell lung cancer patients are eligible for lung cancer surgery.

Surgery for lung cancer usually involves either a large incision or the use of one or more small incisions on the side of your chest near the ribs. The type of incision is defined by one of two methods for lung cancer surgery:

• Thoracotomy – An incision starting on the side of your chest and following the curve of the ribs toward the back, usually requiring the surgeon to spread two ribs apart for access to the lung
• Minimally invasive thoracoscopy – At least one small incision, up to four, where a  camera and instruments are used to visualize and access your lung. This is called video-assisted thoracoscopic surgery (VATS), and may be used in conjunction with robotics technology

There are four types of surgery for lung cancer. They differ in how much of your lung is removed.

The four lung cancer surgeries are:

• Pneumonectomy – Complete removal of the lung affected by a tumor
• Wedge resection – Removing a small, wedge-shaped part of lung tissue surrounding the tumor
• Lobectomy – Each lung has multiple lobes. The right lung has three and the left lung has two. Surgeons can remove 1-2 lobes, or part of a lobe.
• Segmentectomy – Each lung lobe has 2-5 sections. Surgeons can take out 1-4 segments to save healthy tissue in a lobe.

There are two subtypes of lung cancer lobectomy: a bilobectomy and a sleeve lobectomy.

A bilobectomy removes two lobes, which is only performed on the right lung when the lobes to remove are next to each other (such as the upper and middle lobes or the middle and lower lobes, but not the upper and lower lobes).

A sleeve lobectomy removes one lobe plus part of your lung’s bronchus, which is the passageway connecting the lung to your windpipe. The remaining part of the bronchus is then connected to the bronchus for the remaining lobes. A sleeve lobectomy can be performed for either the right or left lung.

Chemotherapy for Lung Cancer

Chemotherapy is the oldest and most commonly used treatment for lung cancer. Chemotherapy aims to kill all diseased cells but can harm your healthy tissue as well.

Most patients receive chemotherapy during one day each cycle, but some may receive treatment on multiple days in a cycle (such as weekly instead of once every three weeks). It is important to discuss the treatment schedule with your oncologist or a family member’s oncologist.

Lung cancer chemotherapy drugs are different for non-small cell lung cancer and small-cell lung cancer. The approved chemotherapy drugs for NSCLC are:

The chemotherapy drugs for SCLC are:

When paired with surgery, chemotherapy is given before surgery (neoadjuvant) or after surgery (adjuvant). Chemotherapy is also used as the primary treatment, either for localized lung cancer or metastasized (advanced) lung cancer.

Chemotherapy is typically given intravenously through an IV catheter into your bloodstream. Another option is during surgery through ports into the chest cavity, this is called intrathoracic chemotherapy.

Side Effects of Chemotherapy for Lung Cancer

Chemotherapy causes side effects, most notably nausea, vomiting and hair loss. Other side effects of lung cancer chemotherapy are:

Chemotherapy also can cause infections or illness due to a low number of white blood cells circulating in your bloodstream. Bruising or bleeding may also occur due to low platelet count.

Some chemotherapy drugs have unique side effects, such as cisplatin and vinorelbine causing nerve damage. You should communicate all side effects with your doctor. If anything is unusual about your experience, they’ll adjust your treatment accordingly.

Most side effects go away once chemotherapy ends. If they don’t for you, then we recommend talking to your physician or oncologist.

Immunotherapy for Lung Cancer

Immunotherapy is used to strengthen your immune system to fight cancer. This approach often causes less side effects than chemotherapy, which destroys cancer cells but can also kill healthy immune cells and weakens the body. Immunotherapy does not have the same impact on your healthy cells.

Immunotherapy alters the tumor microenvironment in some form, either by altering the tumor cells or enhancing the immune cells.

There are a few types of immunotherapy:

Immune Checkpoint Inhibitors for Lung Cancer

The most popular type of immunotherapy for lung cancer is immune checkpoint inhibition. This class of drugs, called immune checkpoint inhibitors, block specific protein receptors on T-cells and cancer cells. These drugs are considered targeted therapies.

Immune checkpoint inhibitors separate these receptors and prevent them from binding together. This helps your T-cells identify cancer cells as dangerous.

The FDA-approved immune checkpoint inhibitors for non-small cell lung cancer are:

In October 2023, the FDA approved Keytruda for patients with “resectable non-small cell lung cancer” as a neoadjuvant treatment (before surgery) in combination with chemotherapy and as an adjuvant therapy (after surgery) on its own.

Keytruda, Opdivo, Tecentriq and Yervoy are approved for small-cell lung cancer. These checkpoint inhibitors are approved for different uses based on pairing with other treatments and stage of lung cancer.

Monoclonal Antibodies for Lung Cancer

Monoclonal antibodies are a class of immunotherapy cancer treatments that produce specific antibodies to target cancer biomarkers, or protein antigens. Antibodies stick to antigens as a way of helping your immune system naturally target and fight cancer cells by registering the antigen as cancerous.

Immune checkpoint inhibitors, a type of monoclonal antibody immunotherapy, are so popular they are often discussed as their own class of drugs. For the purposes of this page, we’ve separated immune checkpoint inhibitors and monoclonal antibodies. Monoclonal antibodies in this section are any drugs that bind to proteins other than immune checkpoints (PD-1, PD-L1, CTLA-4 and B7).

Monoclonal antibodies are a type of targeted cancer therapy. The FDA has approved some monoclonal antibody drugs for non-small cell lung cancer but not for small-cell lung cancer.  Brigatinib, necitumumab and amivantamab are monoclonal antibody drugs approved for use with NSCLC.

Growth Inhibitors for Lung Cancer

Growth inhibitors for lung cancer – also called growth blockers – target specific proteins or receptors that promote cell growth or prevent cell death.

Your healthy tissue cells are made up of proteins and genes that all collaborate to help cells grow, replicate and ultimately die. This cell-life process requires a balanced genetic and protein makeup.

Cancer cells have an unbalanced genetic and protein makeup. Genes and proteins that are supposed to signal your cells to die or stop growing can be suppressed or deleted, while genes helping the cell grow and multiply increase in volume.

The result is these mutated cells don’t die when they should, instead growing and replicating much faster than your healthy cells. Examples of cell growth factors include creating of blood vessels to supply cells with nutrients or managing signaling pathways that tell the cells when to replicate.

Growth inhibitors target these growth factors and prevent them from helping the cancer cell grow and multiply. By slowing down these growth processes, the cancer’s growth slows. Cancer cells may die before they reproduce new mutated cells, which can control or even shrink the tumor.

Other growth inhibitors approved for NSCLC are:

Radiation for Lung Cancer

Radiation sends high-energy electromagnetic rays or particles to slice through and kill cancer cells. This treatment option can be used to treat lung cancer, but it may need to be used cautiously due to the possibility of injuring healthy tissue.

There are two types of radiation for lung cancer: external beam radiation therapy; and brachytherapy, or internal radiation therapy.

Brachytherapy, or internal radiation, is the use of radioactive material in the form of seeds, capsules or ribbons inserted into the body near tumors.

External radiation is the most common type used for lung cancer. External radiation is similar to an X-ray, but the doses are much stronger. Treatment lasts only a few minutes and is painless at the moment, but side effects can occur hours to days later. Patients usually receive radiation treatment five days a week for 5-7 weeks, with variances for the stage of cancer, patient’s health and type of external radiation.

External radiation has a few subtypes. They’re different in how targeted the radiation particles are and the width of the radiation beams. The more targeted and smaller the width of the beam, the more power goes to the targeted tumor area and less damage happens to nearby healthy tissue.

The three subtypes are:

• Intensity-modulated radiation therapy (IMRT) – Three-dimensional therapy shaped to match the tumor’s shape that limits the amount of tissue targeted
• Proton radiation therapy – The newest type of radiation treatment, using proton (atom particles) rather than electromagnetic photons
• Stereotactic body radiation therapy – Highly focused beams with high dosages given 1-5 times rather than daily for a few weeks

According to Memorial Sloan Kettering Cancer Center, stereotactic body radiation therapy is used for most early stage non-small cell lung cancer cases. It is the preferred option for stage 1 or stage 2 cases that are not candidates for surgery.

Radiation can be used before surgery (neoadjuvant), after surgery (adjuvant), or without surgery. If surgery isn’t part of the treatment plan, radiation is likely paired with chemotherapy or immunotherapy. In some late-stage cases of lung cancer, radiation can also be a palliative treatment to relieve symptoms and pain.

Side Effects of Radiation for Lung Cancer

Side effects are possible from radiation therapy. Some of the common effects from this treatment are:

Most of these side effects stop once radiation therapy ends. If they continue, please let your doctor know. They might be able to provide medication to help with side effects of radiation.

Other Lung Cancer Treatment

A few other lung cancer treatments are used in clinical trials, which are testing grounds for novel therapies. A few examples of these are photodynamic therapy, oncolytic virus therapy and gene therapy.

Photodynamic therapy uses light-sensitive drugs to kill cancer cells. Doctors implant these light-sensitizers, or photosensitizing agents, and direct high beams of light to activate the drugs within or near the tumor.

Oncolytic virus therapy delivers engineered viruses into the tumor environment. These viruses are programmed to infect only cancer cells. The virus either signals to the immune cells to swarm to the location, replicates within the cancer cell and breaks it apart, or performs both actions.

Gene therapy tries to change the genetic makeup of the immune cells or cancer cells. Genes can be added, deleted, edited or replaced.

Adoptive Cell Therapy for Lung Cancer

Adoptive cell therapies are within a class of cancer immunotherapy called cell and gene therapy. The most popular kind of adoptive cell therapy is CAR T-cell therapy. CAR stands for chimeric antigen receptor. Doctors remove T-cells from the patient and add a unique receptor in a laboratory to help the cells focus on cancer cells.

CARs are also being explored for NK-cell therapy, another form of engineering immune cells to target abnormal cells.

There are six CAR T-cell therapies approved for the blood cancers leukemia, lymphoma and myeloma, but none have worked consistently for solid tumors such as lung cancer. Other examples of adoptive cell therapy are tumor-infiltrating lymphocytes and engineered T-cell receptors.