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Types of biological therapy

Biological therapies are treatments that can control or stop the growth of cancer cells. Some types of biological therapy can treat advanced non small lung cancer. They include erlotinib (Tarceva), gefitinib (Iressa), crizotinib (Xalkori) and afatinib (Giotrif). 

Other types of biological therapy, such as bevacizumab (Avastin) and cetuximab (Erbitux), are being tested in research trials. Research is also looking at using some biological therapies to treat earlier stages of lung cancer.

Side effects of biological therapies

The side effects vary depending on which drug you have. But the possible side effects of biological therapies for lung cancer include

  • Tiredness (fatigue)
  • Diarrhoea
  • Skin changes (rashes or discolouration) – rashes may be severe for some people
  • A sore mouth
  • Weakness
  • Feeling sick
  • Loss of appetite
  • Low blood counts
  • Swelling of parts of the body, due to build up of fluid

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating lung cancer section.

 

 

Types of biological therapy

Biological therapies are treatments that can control or stop the growth of cancer cells. Some types of biological therapy can treat advanced non small cell lung cancer. They include erlotinib (Tarceva), gefitinib (Iressa), crizotinib (Xalkori) and afatinib (Giotrif).

Doctors are using clinical trials to test other types of biological therapy such as bevacizumab (Avastin) and some very new drugs. Research is also looking at using some biological therapies to treat earlier stages of lung cancer.

 

Erlotinib (Tarceva)

Erlotinib is also known by its brand name, Tarceva (tar-see-vah). You take it as a tablet, once a day. Erlotinib works by blocking particular proteins called epidermal growth factor receptors (EGFR) in the cancer cells. Cancers that have EGF receptors are called EGFR positive. Between 10 and 15 people out of every 100 with non small cell lung cancer (10 to 15%) have EGFR positive cancer. Doctors check your cancer cells to see if they have EGF receptors before you have this treatment. 

You may have erlotinib if you have locally advanced or metastatic non small cell lung cancer which is EGFR positive 

  • As a first line treatment (that is, if you have not had drug treatment before)
  • Or if your cancer has continued to grow despite having chemotherapy (unless you have had two or more types of chemotherapy that did not work and included docetaxel)

Erlotinib is not currently used as standard treatment for early stage non small cell lung cancer (NSCLC). But trials are looking at whether erlotinib can reduce the chance of NSCLC coming back after surgery. Trials are also looking at whether erlotinib with radiotherapy to the head can reduce the chance of lung cancer spreading to the brain. 

Some trials are combining erlotinib with chemotherapy or other biological therapy drugs. You can find out more about research into erlotinib for lung cancer on our lung cancer research page.

We have detailed information about erlotinib and its side effects in the cancer drugs section.

 

Gefitinib (Iressa)

Gefitinib has the brand name Iressa. It also works by blocking epidermal growth factor receptors. It is a tablet that you take once a day.

Doctors can gefitinib as a first treatment for non small cell lung cancer that is locally advanced or has spread. To have gefitinib, the cancer cells must have EGFR receptors.

A meta analysis of trials comparing gefitinib with chemotherapy as a first treatment for people with advanced cancer found that there was no difference in how long people lived. But there was a difference in the side effects. People who had gefitinib had less tiredness, sickness and effects on the blood cells. They did have more skin problems (rashes), diarrhoea, and irritation of the lung. They also had a better quality of life compared to people having chemotherapy.

 

Crizotinib (Xalkori)

Crizotinib has the brand name Xalkori. It can help to control advanced NSCLC in people whose cancer cells have an overactive version of a protein called anaplastic lymphoma kinase (ALK). It is licensed in the UK for people who have already had other treatments for advanced NSCLC. You take it as capsules that you swallow twice a day.

Crizotinib can stop the cancer cells growing for a time but it only works in cancers with the overactive protein. So it is not suitable for everyone. About 1 in 20 people (5%) with non small cell lung cancer (NSCLC) have the overactive ALK protein. 

 

Afatinib (Giotrif)

Afatinib has the brand name Giotrif. It is a type of cancer growth blocker called a protein tyrosine kinase inhibitor (TKI). Tyrosine kinases are proteins that stimulate cells to grow. Afatinib blocks tyrosine kinases and also blocks the epidermal growth factor receptor proteins in cancer cells. Doctors check your cancer cells to see if they have the receptors before you have this treatment.

Doctors can use afatinib for people with advanced non small cell lung cancer if they have not already had any other type of cancer growth blocker. You take it as a tablet every day. 

Research comparing afatinib to chemotherapy for advanced non small cell lung cancer has shown that it helps to control symptoms better. And it may be better at controlling the growth of the cancer for a longer time.

Currently afatinib is available through the cancer drugs fund in England. The Scottish Medicines Consortium (SMC) has approved it as a treatment in Scotland. 

 

Other biological therapies for lung cancer

Other types of biological therapy being used in trials for lung cancer include

Cetuximab (Erbitux)

Cetuximab is a monoclonal antibody which blocks growth factor receptors on cells. It has been used, with chemotherapy, in trials for advanced non small cell lung cancer. The results so far have been quite encouraging in terms of helping people to live longer. Research is continuing to try to find the best way of using cetuximab.

Bevacizumab (Avastin)

Bevacizumab (also called Avastin) is a monoclonal antibody (MAB) that stops cancer cells making the blood vessels they need so that they can grow. Bevacizumab is licensed in Europe to treat advanced non small cell lung cancer in combination with platinum based chemotherapy, such as cisplatin or carboplatin. This treatment has not been approved by the National Institute for Health and Care Excellence (NICE)  and so is not used as a standard treatment on the NHS in the UK.

A recently published American study found that adding bevacizumab to carboplatin and paclitaxel chemotherapy didn't work any better than the chemotherapy alone. This study was looking at people who were over the age of 65 years with stage 3B or stage 4 non small cell lung cancer

New biological therapy drugs

Clinical trials for lung cancer are looking at many new biological therapy drugs. You can find out about them on the lung cancer research page. Or go to our clinical trials database. Go to the advanced search and choose 'lung cancer' from the dropdown menu of cancer types and 'biological therapy' from the list of treatment types. If you want to see all the trials, tick the boxes for closed trials and trial results.

 

Side effects of biological therapies

The side effects vary depending on which drug you have. But the possible side effects of biological therapies for lung cancer include

Tell your doctor or nurse if you have any of these effects as you can have medicines to help to control them. There is information about the side effects of individual biological therapies in our cancer drugs section.

 

Getting more information about biological therapies

There is detailed information in the biological therapy section. You can ask your doctor or specialist nurse to write down the names of your drugs so you can look them up in the cancer drugs section. You can phone the Cancer Research UK nurses for information on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.

Our lung cancer organisations page gives details of people who can give information about lung cancer biological therapies. Some organisations can put you in touch with a cancer support group. Our lung cancer reading list has information about books and leaflets on lung cancer treatments.

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 31 March 2014