When might targeted therapy be used for lung cancer?
Targeted therapy can be used to treat advanced forms of non-small cell lung cancer (NSCLC). These are bigger tumors that have spread from where they first started in the lung. They might also be used after surgery for smaller (stage I) tumors. They might be used alone or along with other treatments.
So far, no targeted therapy medicines have been shown to help treat small cell lung cancer (SCLC).
Most targeted therapies are only helpful if the cancer cells have certain gene changes. So if you have NSCLC, your doctor will have lab tests done on your cancer cells to look for certain proteins and gene changes. This helps your doctor know if and which targeted therapy medicine might work for you.
Types of targeted therapy for non-small cell lung cancer
Some targeted therapy medicines aim for a protein on cells called the epidermal growth factor receptor (EGFR). Sometimes NSCLC cells make too many of these growth factor receptors. When EGFR attaches to these receptors, signals are sent to help the cell grow and divide faster. Blocking EGFR stops these signals and can keep the cancer cell from growing.
These are some of the medicines that can be used if your lung cancer cells have certain EGFR gene changes (mutations):
All of these medicines are taken as pills.
Necitumumab is an EGFR inhibitor that can be used in people with the squamous cell sub-type of NSCLC. This medicine is given by IV (intravenous) infusion into a vein.
Some targeted therapy medicines target new blood vessel growth. This process is called angiogenesis. Tumors need new blood vessels to grow. So keeping the tumors from making new blood vessels can help keep them from growing. These medicines are often used along with chemotherapy for more advanced NSCLC:
These medicines are given by IV. They go right into your blood through a vein.
A small number of NSCLCs have changes in the ALK gene. This change produces an abnormal ALK protein that causes the cancer cells to grow and spread. Medicines that target the abnormal ALK protein can often help shrink tumors. They're often used instead of chemo. They might also be used if chemo stops working. ALK inhibitors include:
These medicines are all taken as pills.
Other treatment targets
Scientists have found other gene and protein changes in NSCLC cells that can be the focus of targeted therapy. These cancer cell changes are less common, but if they're found, targeted therapy can be used.
ROS1 gene changes
Changes in the ROS1 gene are most often found in people with the NSCLC sub-type called adenocarcinoma. These cancer cells usually don't have ALK or EGFR mutations. Medicines that target abnormal ROS1 include:
All of these are taken as pills.
BRAF gene changes
Changes in the BRAF gene allow cancer cells to make an altered BRAF protein that helps them grow and spread.
Dabrafenib and trametinib may be used together to treat NSCLCs with a certain kind of BRAF gene mutation. These medicines are taken as pills.
RET fusion gene changes
Abnormal RET proteins are made when the RET fusion is changed. This leads to out-of-control cancer cells growth.
RET inhibitors include:
They attack the RET protein to slow cancer cell growth. They're taken as pills.
MET gene changes
MET gene changes cause cancer cells to make abnormal MET proteins that help them grow and spread.
Capmatinib is a MET inhibitor. It attacks the MET protein. It's taken as pills.
NTRK fusion gene changes
Changes in NTRK fusion can cause cancer cell growth.
Larotrectinib and entrectinib target and damage the proteins made by the NTRK genes. These medicines are taken as pills.
Possible side effects of targeted therapy
You may have side effects from your treatment. The possible side effects can vary a great deal depending on which medicine you are getting.
Side effects of EGFR inhibitors can include:
Common side effects of angiogenesis inhibitors include:
Less common, but more serious side effects include:
Holes in the intestines
Slow wound healing
Common side effects of ALK inhibitors include:
Common side effects of ROS1 inhibitors include:
Side effects of medicines that target BRAF gene changes include:
Skin changes, like thickening, rashes, itching, and sun sensitivity
RET inhibitor side effects include:
Common MET inhibitor side effects include:
Side effects of medicines that target NTRK gene change s include:
Working with your healthcare provider
It's important to know which targeted therapy medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause. Tell them about any changes you notice so they can help you control them. Most side effects can be treated, and there may be ways to keep them from getting worse.
Talk with your healthcare providers about what signs to look for and when to call them. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?
It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.