Chemotherapy for lung cancer

When you might have chemotherapy

Small cell lung cancer

Chemotherapy is the main treatment for small cell lung cancer. Doctors use it because this type of cancer responds well to chemotherapy. And small cell lung cancer has often spread beyond the lung by the time it is diagnosed.

Chemotherapy circulates around the body in the bloodstream. This means it can treat cancer cells that have broken away from the lung tumour and spread to other parts of the body.

On its own

You might have chemotherapy on its own to treat small cell lung cancer.

Before, after or with radiotherapy

You might have chemotherapy before or after radiotherapy or at the same time as radiotherapy.

Before or after surgery

If you are going to have surgery for very early small cell lung cancer, your doctor might suggest that you have chemotherapy before or after your operation.

With immunotherapy

You might have chemotherapy with immunotherapy for small cell lung cancer for both limited and extensive disease.

Non small cell lung cancer (NSCLC)

Chemotherapy is a common treatment for early stage and advanced (metastatic) non small cell lung cancer.

Before or after surgery

Some people might have chemotherapy in combination with immunotherapy before surgery. This is called neoadjuvant treatment. This can shrink the cancer and make it easier to remove.

For early stage NSCLC, chemotherapy after surgery (adjuvant chemotherapy) can help to lower the risk of the cancer coming back. If your cancer has a high amount of checkpoint protein PD-L1 (more than 50%), your doctor may recommend immunotherapy after your adjuvant chemotherapy. If your lung cancer tests positive for the EGFR gene change (mutation), your doctor may recommend further treatment with the targeted drug osimertinib after your adjuvant chemotherapy.

It is important that your doctor talks to you beforehand about the benefits and possible risks of chemotherapy, immunotherapy or osimertinib after surgery. The drugs can cause side effects. Chemotherapy and immunotherapy tend to work best in fit patients. If you are fit enough to have chemotherapy and immunotherapy. You usually start it within 8 weeks of having surgery.

Before, after or with radical radiotherapy

Giving chemotherapy before or after radiotherapy can sometimes help to get rid of early stage NSCLC in people who can’t have surgery.

If you are well enough, your doctor might suggest combined treatment with radical radiotherapy and chemotherapy. This is called concurrent chemoradiotherapy. This is often followed by immunotherapy.

Metastatic (advanced) cancer 

If your cancer has spread, you might have chemotherapy, immunotherapy or both. This will depend on:

• how fit you are

• the amount of checkpoint proteins PD-L1 on your cancer cells

• whether your cancer has specific gene changes (mutations)

These treatments can relieve symptoms. It can also control the cancer and improve your quality of life for a time, but they do not usually cure advaned cancer.

Your doctor will talk to you in detail about the possible risks and benefits of these treatments. These treatments won’t help everybody. It will depend on how fit you are, and how well you can cope with any side effects.

Types of chemotherapy

Treatment for small cell lung cancer is different to non small cell lung cancer.

Small cell lung cancer

Limited disease

You usually have a combination of chemotherapy drugs, including either cisplatin or carboplatin. Combinations include:

• cisplatin and etoposide

• carboplatin and etoposide

Extensive disease

You usually have chemotherapy with an immunotherapy drug if you are fit enough:

• carboplatin and etoposide with atezolizumab or durvalumab

• cisplatin and etoposide with durvalumab

Small cell lung cancer usually responds well to these treatments. Researchers continue to test new combinations to see if they can either improve the results, lessen the side effects, or both.

If your cancer comes back

If your cancer comes back, you might have further treatment. This may include standard treatments or a clinical trial. Possible treatment options include:

• carboplatin and etoposide

• cyclophosphamide, doxorubicin and vincristine (CAV)

• topotecan

• lurbinectedin

• paclitaxel

• temozolomide

• irinotecan

• gemcitabine with or without carboplatin

• tarlatamab

Non small cell lung cancer

You are most likely to have cisplatin or carboplatin with at least one other chemotherapy drug such as:

• pemetrexed

• vinorelbine

• gemcitabine

• paclitaxel (Taxol)

• docetaxel (Taxotere)

You might have the above drugs with immunotherapy or sometimes with a targeted cancer drug. This depends on your cancer stage and any gene changes in the cancer.

Your doctor will tell you more about what treatment would work best for you.

Metastatic non small cell lung cancer

You might have chemotherapy with immunotherapy for metastatic non small cell lung cancer. You might have one of the following:

• carboplatin or cisplatin with pemetrexed and pembrolizumab

• carboplatin and paclitaxel and bevacizumab and atezolizumab

• carboplatin and paclitaxel and atezolizumab

• carboplatin and paclitaxel and pembrolizumab

Read more about immunotherapy for lung cancer

If you are not well enough to have targeted drugs or immunotherapy, you may have a single chemotherapy drug. You might have:

• gemcitabine

• paclitaxel

• docetaxel

• vinorelbine

Check the name of the chemotherapy treatment with your doctor or nurse, then find out about it on our A to Z list of cancer drugs.

A to Z list of cancer drugs

How you have chemotherapy

You have most chemotherapy drugs into your bloodstream but some are capsules or tablets that you swallow.

Into your bloodstream

You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment. This means your doctor or nurse won't have to put in a cannula every time you have treatment.

Taking your tablets

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.

Treatment cycles

Chemotherapy is usually given in cycles. For example, you might have treatment on one day followed by a break of 2-3 weeks before the next cycle. The breaks are important to allow your body to recover. This 3 week period in total is one cycle of treatment.

Take your cancer drugs exactly as your doctor, specialist nurse or pharmacist has told you to. The break from treatment is important too. For many cancer drugs, it allows your body to recover.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day unit. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You may have a small portable pump to take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have blood tests before each cycle of treatment.

Your blood cells need to recover from your last treatment before you have more chemotherapy. Sometimes your blood counts have not recovered enough. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test.

Side effects

Common chemotherapy side effects include:

• feeling sick

• loss of appetite

• losing weight

• feeling very tired

• increased risk of getting an infection

• bleeding and bruising easily

• diarrhoea or constipation

• hair loss

Side effects depend on:

• which drugs you have

• how much of each drug you have

• how you react

Tell your treatment team about any side effects that you have.

Read more about the common side effects of chemotherapy and how to cope

Dietary or herbal supplements and chemotherapy

Tell your doctors if you:

• take any supplements

• have been prescribed anything by alternative or complementary therapy practitioners

It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.

Read about the safety of complementary and alternative therapies

When you go home

Chemotherapy for lung cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. Your healthcare team will give you telephone numbers to call if you have any problems at home.