Treatment of non-small cell lung cancer by stage (2023)

Treatment options for non-small cell lung cancer (NSCLC) are based primarily on the stage (extent) of the cancer, but other factors such as your overall health and lung function are also important. a person, and certain characteristics of the cancer itself.

If you smoke, one of the most important things you can do is be prepared for treatment.try to walk. Studies have shown that people who quit smoking after being diagnosed with lung cancer tend to have better outcomes than those who don't.

Treatment of hidden cancer

In these cancers, malignant cells are seen on sputum cytology, but no obvious tumors can be found with bronchoscopy or imaging tests. Usually these are early stage cancers.bronchoscopyand other tests may be repeated every few months to look for a tumor. If a tumor is found, treatment depends on the stage.

Treat stage 0 NSCLC

Because stage 0 NSCLC is confined to the lining of the airways and has not penetrated deeply into lung tissue or other areas, it can usually only be cured with surgery. No chemotherapy or radiation therapy is required.

if you are healthy enoughOperation, can usually be treated by segmentectomy or wedge resection (removal of part of the lobe of the lung). Cancer in some sites (such as where the trachea divides into the left and right mainstem bronchus) can be treated with tube resection, but in some cases it may be difficult to remove it completely without a flap (lobectomy) or even remove an entire lung (pneumonectomy).

For some stage 0 cancers, treatments such as photodynamic therapy (PDT), laser therapy, or brachytherapy (internal radiation) may be alternatives to surgery. If your cancer is really stage 0, these treatments should cure it.

Treat stage I NSCLC

If you have stage I NSCLC,Operationit may be the only treatment you need. This can be done by removing the lobe of the lung that contains the tumor (lobectomy) or by removing a smaller part of the lung (sleeve resection, segmentectomy, or wedge resection). At least some lymph nodes in the lungs and in the space between the lungs are removed and checked for cancer.

A segmentectomy, or wedge resection, is generally only an option for very small stage I cancers and for patients with other medical conditions that make removal of the entire flap dangerous. Still, most surgeons believe that a lobectomy is best performed when the patient can tolerate it, as it offers the best chance of recovery.

For people with stage I NSCLC who are at increased risk of recurrence (based on size, location, or other factors), adjuvantchemotherapy(and possiblyimmunotherapy) after surgery can lower the risk of the cancer coming back. However, clinicians are not always sure how to determine which patients may benefit from adjuvant therapy. New laboratory tests that look at the patterns of certain genes in cancer cells could help here.

(Video) Treatment and Management of Non-Small Cell Lung Cancer (NSCLC)

After the operation, the removed tissue is placed on the edges of the surgical specimen (so-calledpositive margin). This could mean that some of the cancer has been left behind, so a second operation may be done to make sure that all of the cancer has been removed. (This can also be followed by chemotherapy.) Another option can be the applicationradiotherapyafter the operation.

For stage I cancer that is 4 centimeters in diameter, there is another treatment optionimmunotherapywith nivolumab along with chemotherapy before surgery. Additional therapy may be needed after surgery depending on what is found at the time of surgery.

If you have serious health problems that prevent surgery, your main treatment may be stereotactic body radiation (SBRT) or another type of radiation therapy. Radiofrequency ablation (RFA) may be another option if the tumor is small and outside of the lungs.

Treat stage II NSCLC

People who have stage II NSCLC and are healthy enough to have itOperationThe cancer is usually removed by lobectomy or sleeve resection. Sometimes it is necessary to remove the entire lung (pneumonectomy).

Any lymph nodes that are likely to contain cancer are also removed. The extent of lymph node involvement and whether cancer cells are found at the edges of the removed tissue are important factors in planning the next step in treatment.

After the operation, the tissue removed from the edges of the surgical sample is examined for cancer cells. This could mean that some cancer has been left behind, so a second operation may be done to try to remove any remaining cancer. This may be followed by adjuvant (additional) treatment with chemotherapy (chemotherapy), possibly followed by adjuvant treatmentimmunotherapyup to one year. Another option is treatmentradiation, sometimes withchemotherapy.

Even if no positive margins are found, adjuvant chemotherapy (and possibly immunotherapy) may be recommended after surgery to try to kill any remaining cancer cells. Newer laboratory tests being studied could help doctors identify which patients need this adjuvant treatment and which are less likely to benefit.

For stage II cancer larger than 4 centimeters in diameter, another treatment option is immunotherapy with nivolumab along with chemotherapy before surgery (known astherapy neoadjuvante). Additional therapy may be needed after surgery depending on what is found at the time of surgery.

For people whose cancer cells have certain mutations in theEGFRgene, adjuvant treatment with thetarget drugOsimertinib could also be an option at some point.

(Video) Immunotherapy Treatments for Non-Small Cell Lung Cancer (NSCLC)

If you have serious medical problems that would prevent surgery, you may only receive radiation therapy as the main treatment.

Treat stage IIIA NSCLC

Initial treatment for stage IIIA NSCLC may involve a combination ofradiotherapy,chemotherapy(chemotherapy) and/orOperation. For this reason, treatment planning for stage IIIA NSCLC generally requires the involvement of a medical oncologist, radiation oncologist, and thoracic surgeon. Your treatment options depend on the size of the tumor, where it is in the lungs, which lymph nodes it has spread to, your general health, and how well you are tolerating treatment.

For patients who can tolerate it, treatment usually begins with chemotherapy, often combined with radiation therapy (also called radiotherapy).Radioquimioterapia). Surgery may be an option after that if the doctor thinks any remaining cancer can be removed and the patient is healthy enough.

There is another treatment option for certain stage IIIA cancersimmunotherapywith nivolumab along with chemotherapy first and then surgery. Additional therapy may be needed after surgery depending on what is found at the time of surgery.

In some cases, surgery may be an option as the first treatment. This is usually followed by adjuvant chemotherapy, which in turn may be followed by adjuvant chemotherapy.immunotherapysometimes up to a year. Adjuvant radiation therapy may also be an option if it has not been done before. For people whose cancer cells have certain mutations in theEGFRgene, adjuvant treatment with thetarget drugOsimertinib could also be an option at some point.

Radiation therapy, which can be combined with chemotherapy, is often used in people who are not healthy enough to have surgery.

When surgery, radiation therapy, and chemoradiotherapy are unlikely to be good treatment options, aimmunotherapyMedications such as pembrolizumab (Keytruda) or cemiplimab (Libtayo) may be considered as initial treatment.

Treat stage IIIB NSCLC

Stage IIIB NSCLC has spread to lymph nodes near the other lung or in the neck, and may also have grown to important structures in the chest. These cancers cannot be completely removed.Operation.

As with other stages of lung cancer, treatment depends on the general health of the patient. If you are healthy, you can be helpedchemotherapy(chemo) combined withradiotherapy(known asRadioquimioterapia). Some people can even be cured with this treatment. If the cancer remains under control after 2 or more chemoradiotherapy treatments, theimmunotherapyThe drug durvalumab (Imfinzi) can be given for up to a year to keep the cancer stable.

(Video) Targeted Therapy in Non-Small Cell Lung Cancer

Patients who are not healthy enough for this combination are often treated with radiation therapy alone or, more rarely, chemotherapy alone. When surgery, radiation, and chemoradiotherapy are unlikely to be good treatment options, aimmunotherapyMedications such as pembrolizumab (Keytruda) or cemiplimab (Libtayo) may be considered as initial treatment.

These types of cancer can be difficult to treat, so attending aclinical studyof newer treatments may be a good option for some people.

Treat stage IVA and IVB NSCLC

Stage IVA or IVB NSCLC has already spread when it is diagnosed. These cancers can be very difficult to cure. Treatment options depend on where and how far the cancer has spread, whether the cancer cells have specific gene or protein changes, and your general health.

If you are in good health, treatments such asOperation,chemotherapy(Chemotherapy),Targeted Therapy,immunotherapy, zradiotherapyIt can help you live longer and feel better by relieving symptoms, although it's unlikely to cure you.

Other treatments such as photodynamic therapy (PDT) or laser therapy may also be relieve symptoms. In either case, if you are going to be treated for advanced NSCLC, make sure you understand your treatment goals before you begin.

NSCLC that has spread to only one other site (stage IVA)

Cancer that is confined to the lungs and has only spread to another location (such as the brain) is not common, but can sometimes be treated (and possibly even cured) with surgery and/or radiation therapy to close the treatment area where there is cancer. spread, followed by lung cancer treatment. For example, a single brain tumor can be treated with surgery or stereotactic radiation, or surgery followed by radiation to the whole brain. Treatment of the lung tumor is then based on its T and N stages and may include surgery, chemotherapy, radiation therapy, or some combination of these.

NSCLC that has spread widely (Stage IVB)

If you have cancer that has spread widely in your body, you should have yourthe tumor is testedfor certain gene mutations (as inKRAS,EGFR,ALK,ROS1,BRAF,WITHDRAWN,HE KNEW, oNTRKgenes). If any of these genes mutate in your cancer cells, your first treatment will probably be aTargeted TherapyMedicine:

  • For people whose cancer is theKRASG12C generationFor example, a KRAS inhibitor such as sotorasib (Lumakras) or adagrasib (Krazati) may be used after trying another drug.
  • For tumors that haveALKgenerationInstead, an ALK inhibitor can often be the first treatment. Another ALK inhibitor may be used if one or more of these drugs stops working or is not well tolerated.
  • For people whose cancer has certain changes in theEGFRgeneration, an EGFR inhibitor may be used as first-line treatment (sometimes with a targeted drug that affects the growth of new blood vessels).
  • For people whose cancer changes in theROS1generationYou can use medications such as crizotinib (Xalkori), entrectinib (Rozlytrek) or ceritinib (Zykadia).
  • For people whose cancers show any changeBRAFgeneration, a combination of the targeted drugs dabrafenib (Tafinlar) and trametinib (Mekinist) may be used.
  • For people whose cancer has certain changes in theWITHDRAWNgeneration, selpercatinib (Retevmo) or pralsetinib (Gavreto) can be used.
  • For people whose cancer has certain changes in theHE KNEWgeneration, capmatinib (Tabrecta) or tepotinib (Tepmetko) may be options.
  • For people whose cancers show a changeNTRKgeneration, larotrectinib (Vitrakvi) or entrectinib (Rozlytrek) may be an option.

Your tumor cells can also be tested for them.PD-L1-Protein. Tumors with higher levels of PD-L1 are more likely to respond to certainimmunotherapymedications (so-calledImmune Checkpoint Inhibitors), which can be an option alone or with chemotherapy.

For most other types of cancer that have spreadchemotherapyit is usually at least part of the main treatment, as long as the person is healthy enough for it. It is often used together with other types of medicines:

(Video) Current Management of Stage IIIA Non-Small Cell Lung Cancer: A Changing Paradigm (November 10, 2022)

  • Chemotherapy may be used along with aimmunotherapysuch as aspembrolizumab (Keytruda), atezolizumab (Tecentriq), or cemiplimab (Libtayo), in some situations. Another option may be a combination of immunotherapy drugs such as nivolumab (Opdivo) plus ipilimumab (Yervoy) or durvalumab (Imfinzi) plus tremelimumab (Imjuno).
  • For people who are not at high risk of bleeding (ie, do not have NSCLC with squamous cell carcinoma and do not cough up blood), the target drugBevacizumab (Avastin)it can be given along with chemotherapy. Some people with squamous cell carcinoma can still receive bevacizumab as long as the tumor is not near large blood vessels in the middle of the chest. When bevacizumab is used, it is often continued even after chemotherapy has been stopped.
  • One option for people with squamous NSCLC is chemotherapy along with the targeted drugNecitumumabe (Portrazza).

If fluid has collected in the space around the lungs (malignant pleural effusion) due to cancer, the fluid may drain. If it keeps coming back, options include pleurodesis or placing a chest catheter through the skin to allow the fluid to drain. (Details will be discussed inPalliative care in non-small cell lung cancer.)

As with other stages, treatment for stage IV lung cancer depends on the person's general health. For example, some people with health problems may receive only 1 chemotherapy drug instead of 2. For people who cannot receive chemotherapy, radiation therapy is often the treatment of choice. Local treatments, such as laser therapy, photodynamic therapy, or stenting, can also be used to relieve symptoms caused by lung tumors.

Because any treatment is unlikely to cure these cancers, participating in a clinical trial of newer treatments may be a good option.

For more information on living with stage IV cancer, see alsoadvanced cancer.

NSCLC that progresses or recurs after treatment

Whether the cancer continues to grow (progression) or comes back (recurrence) during treatment depends on the location and extent of the cancer, the treatments used, and the person's medical condition and desire for further treatments. It is important to understand the purpose of any subsequent treatment, whether it is to cure the cancer, slow its growth, or relieve symptoms. It is also important to understand the benefits and risks.

If the cancer continues to grow during the initial treatment, such asradiotherapy,chemotherapy(chemotherapy) can be tried. If a cancer continues to grow while you are receiving chemotherapy as first-line treatment, second-line treatment usually consists of a single chemotherapy drug, such as B. docetaxel or pemetrexed, orTargeted Therapy. If a targeted drug was the first treatment and it no longer works, another targeted drug or combination chemotherapy may be tried. For some people with certain types of NSCLC, treatment with aimmunotherapyMedications such as nivolumab (Opdivo), sometimes along with ipilimumab (Yervoy); pembrolizumab (Keytruda); or atezolizumab (Tecentriq) may be an option.

Minor cancers that recur locally in the lungs can sometimes be retracted (if not used before) by surgery or radiation therapy. Cancer that comes back in the lymph nodes between the lungs is usually treated with chemotherapy, possibly radiation if it has not been used before. For cancers that recur in distant sites, chemotherapy, targeted therapies, and/or immunotherapy are often the treatments of choice.

For more information on handling retries, seeunderstand repetition.

In some people, the cancer may never go away completely. These people may receive regular chemotherapy, radiation therapy, or other therapies to try to control the cancer. Learning to live with cancer that does not go away can be difficult and very stressful. He has his own kind of insecurity.Treat cancer as a chronic diseasetalk more about it.

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