This article will review the types of lung cancer and the first-line treatments recommended for each.
Types of Lung Cancer
There are two main types of lung cancer—small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). Knowing the type of lung cancer as well as the stage of the cancer are critical pieces of information the oncologist (a specialist in diagnosing and treating cancer) needs to make treatment decisions.
Small Cell Lung Cancer
Small cell lung cancer begins growing in the cells of the lung, and can quickly grow and begin to spread into other areas of the body, such as the brain, bones, or liver. SCLC tends to be more aggressive than NSCLC. An estimated 13% of newly diagnosed lung cancers are SCLC.
Non-Small Cell Lung Cancer
NSCLC is the most common type of lung cancer, estimated to be over 80% of newly diagnosed lung cancers. NSCLC can be further classified into three subtypes, shown here in order of most to least common:
AdenocarcinomaSquamous cell carcinomaLarge-cell carcinoma
Treatment Options
There are several first-line treatments for lung cancer that may be used individually or in combination with one other. These include:
SurgeryChemotherapyRadiation therapyImmunotherapy
Surgery
Surgical removal of the lung tumor and nearby lymph nodes is most often used to treat lung cancer when the tumor is small and unlikely to have spread into nearby tissue. Lung cancer surgery can involve removing only one lobe of the lung or may involve removing an entire lung.
Chemotherapy
Chemotherapy is medication that kills cancer cells. It works by targeting cells during specific times in their reproductive cycles in order to stop the cells from growing. Different chemotherapy medications work at varying points in a cell cycle. It is considered a systemic therapy as it affects cells throughout the body.
Radiation Therapy
Radiation works by damaging the DNA (hereditary material) inside of the cancer cell so that it is not able to continue to replicate and grow. It’s given by a specialized machine that directs beams of radiation to the prescribed area. Radiation is a local therapy, treating only the area where the beam is directed.
Immunotherapy
Immunotherapy is another systemic treatment for cancer, but works much differently than chemotherapy. It includes various treatments that help the immune system recognize cancer cells and stop their growth or spread. These treatments include:
Checkpoint inhibitors such as Keytruda (pembrolizumab), Tecentriq (atezolizumab), and Libtayo (cemiplimab) Monoclonal antibodies such as Avastin (bevacizumab) Cyramza (ramucirumab), and Portrazza (necitumumab)
Targeted Therapy
Some lung cancers have specific mutations (genetic changes) that are partly responsible for the abnormal growth of the cancer cells. Some of these mutations have medications that are available to specifically target them, to help stop or slow the growth of the cancer.
First-Line Treatment for Small Cell Lung Cancer
The first-line treatments for SCLC depend upon the stage of the cancer, meaning how far advanced the cancer is. SCLC is categorized as either limited stage or extensive stage. The first-line treatment for limited-stage SCLC can include:
Chemotherapy and radiation therapy given togetherChemotherapy alone, which can include a combination of medicationsSurgery, followed by chemotherapy Surgery, followed by chemotherapy and radiation
Extensive-stage SCLC may be treated by:
Combination of chemotherapy and immunotherapyChemotherapy aloneRadiation to specific areas where cancer is causing symptoms, followed by chemotherapy alone or with immunotherapy
First-Line Treatment for Non-Small Cell Lung Cancer
NSCLC treatment is also based upon its stage, ranging from 1 to 4.
Stage 1
The following treatment options can be used for stage 1 NSCLC:
Surgery aloneSurgery, followed by targeted therapyRadiation alone
Stage 2
The following treatment options can be used for stage 2 NSCLC:
Surgery aloneChemotherapy, followed by surgerySurgery, followed by chemotherapySurgery, followed by targeted therapyRadiation alone
Stage 3
The following treatment options can be used for stage 3 NSCLC:
Chemotherapy, followed by surgeryChemotherapy and radiation together, followed by surgerySurgery, followed by chemotherapySurgery, followed by targeted therapySurgery, followed by chemotherapy and radiation therapy, followed by immunotherapySurgery, followed by radiationChemotherapy and radiation together, followed by immunotherapyRadiation alone
Stage 4
Stage 4 NSCLC treatment options include:
Combination of chemotherapy medicationsChemotherapy combined with targeted therapyChemotherapy aloneTargeted therapy alone, based upon results of genomic testingImmunotherapy alone
When First-Line Treatment Doesn’t Work
Regardless of the type of lung cancer, first-line treatments are given with the expectation that those treatments offer the best chance of curing the cancer or keeping it from growing and spreading. If cancer does not respond to the treatment that was used, different types of treatment or different chemotherapy agents may be needed.
The types of chemotherapy that are used after first-line treatments may not be as effective or work for as long as the initial treatments did. Further testing of the cancer may be needed, such as molecular testing, to see if any targeted therapy can be used.
Molecular or genomic testing looks at the genes inside cancer cells to identify the presence of biomarkers (substances produced by cancer cells or other cells in response to cancer). Biomarkers are different for each person’s cancer, and if certain biomarkers are present in lung cancer, additional treatment options may be available.
These targeted medications are often not chemotherapy but are medications that target a specific biomarker, affecting how the cancer grows.
Summary
First-line treatments for lung cancer are those given as the initial treatment after diagnosis. The first-line treatments for lung cancer depend upon the stage of the cancer as well as the type. For SCLC, chemotherapy is a standard first-line treatment. For NSCLC, first-line treatment may consist of chemotherapy, radiation and/or surgery.
A Word From Verywell
Getting a diagnosis of lung cancer can be a time of anxiety and uncertainty. Sometimes it can feel like forever for scans to get done and results to be return, but these these are necessary, as they allow the oncologist to develop the best treatment plan for you.
