Chemotherapy for lung cancer

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Cytotoxic means toxic to cells. Chemotherapy is an important treatment for lung cancer.

Sometimes cancer drugs are called systemic anti-cancer drugs as they treat cancer throughout the body. They are sometimes called SACT drugs for short.

Other SACT drugs called targeted or immunotherapy drugs are sometimes given along with chemotherapy for lung cancer. They work differently to chemotherapy and have different side effects. Chemotherapy is also given with radiotherapy and surgery. 

Lung cancer drugs are usually given into a vein (intravenous). You usually have chemotherapy as an outpatient.

The chemotherapy drugs can be given through:

• a cannula – a short, thin tube the nurse puts into a vein in your arm or hand
• a central line – a fine tube that goes under the skin of your chest and into a vein close by
• a PICC line – a fine tube that is put into a vein in your arm and goes up into a vein in your chest
• an implantable port (portacath) – a disc that is put under the skin on your chest or arm and goes into a vein in your chest.

When your cannula, line or port is in place, the chemotherapy drugs can be given into it by injection, as a drip or through a pump.

Some lung cancer drugs are taken as tablets or capsules that you swallow. This is called oral chemotherapy.

We have more information about how chemotherapy is given.

Chemotherapy is often used to treat non-small cell lung cancer. You might be given a combination of chemotherapy drugs with other lung cancer drugs or treatments.

You might have chemotherapy before or after surgery for lung cancer.

Neoadjuvant chemo-immunotherapy

Sometimes chemotherapy and an immunotherapy drug called nivolumab are given before surgery. This is usually if the tumour in the lung is bigger, or the cancer has spread to nearby lymph nodes. The aim is to shrink the cancer and make surgery more effective. This is called neoadjuvant chemo-immunotherapy. Immunotherapy drugs are also given as a drip into a vein. They work differently to chemotherapy and have their own side effects.

Adjuvant chemotherapy

After surgery to remove lung cancer your doctor might advise you to have chemotherapy. The aim is to reduce the risk of the lung cancer coming back. This is called adjuvant chemotherapy.

If you have locally advanced NSCLC lung cancer and surgery is not suitable you might have chemotherapy at the same time as radiotherapy. This is called concurrent chemoradiation.

You usually start your chemotherapy during the first week of radiotherapy. Or you might have 1 cycle of chemotherapy while your radiotherapy is being planned.

If the cancer is advanced, some people might have the chemotherapy drugs carboplatin and paclitaxel with the immunotherapy drug pembrolizumab.

The chemotherapy drugs pemetrexed with either cisplatin or carboplatin can also be given with pembrolizumab. You might have this if you have non-squamous NSCLC and targeted drugs are not likely to work for you.

Chemotherapy can also be given with other immunotherapy drugs, including atezolizumab and bevacizumab.

We have more information about lung cancer and immunotherapy drugs.

Sometimes chemotherapy is given on its own. This might be when targeted or immunotherapy drugs are not likely to work for you.

You usually have a combination of either carboplatin or cisplatin, along with another drug. For example, gemcitabine, paclitaxel or vinorelbine.

If you have non-squamous type NSCLC you might be given the chemotherapy drug pemetrexed with carboplatin or cisplatin.

Other combinations of chemotherapy may also be given.

If you are not well enough, you might have 1 chemotherapy drug on its own.

Maintenance chemotherapy for NSCLC

If you had chemotherapy with pemetrexed and cisplatin or carboplatin and it helped shrink or control the cancer, you might continue with chemotherapy. This is sometimes called maintenance treatment.

Instead of stopping chemotherapy after a few cycles, you have pemetrexed every 3 weeks. You have it for as long as it is controlling the cancer, and the side effects are not causing you problems.

The aim is to control the cancer and help you live for longer.

If NSCLC comes back, or is starting to grow again, you can usually have more chemotherapy. You and your doctor and nurse can talk about your options. It can also depend on how well you are at the time.

It can be very difficult to learn that the cancer has come back. Your cancer team will give you support. It might be helpful to talk about your feelings with family or friends.

Your treatment will depend on the chemotherapy drugs you had when you were first treated. If these drugs kept the cancer away for a long period, your doctor may advise having them again. For example, you could have cisplatin or carboplatin with another drug.

Or your doctor may recommend docetaxel on its own, or with a targeted therapy called nintedanib. Or you might have chemotherapy with an immunotherapy drug.

Your cancer doctor, nurse or pharmacist will give you information about the possible side effects of the chemotherapy drugs you are having. They will talk to you about how they can be controlled and what you can do to manage them. Always tell your doctor, nurse or pharmacist about any side effects you have.

We have more information about the side effects of chemotherapy.