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About chemotherapy for advanced cancer

Advanced lung cancer is a cancer that began in the lung and has spread to another part of the body.

What is chemotherapy?

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

Aim of chemotherapy

Chemotherapy for advanced lung cancer can relieve symptoms. It can also control the cancer and improve your quality of life for a time, but it can’t cure the cancer.

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

Chemotherapy for advanced small cell lung cancer

You usually have a combination of chemotherapy drugs.

The possible combinations include:

  • EP (cisplatin and etoposide)
  • Carboplatin and etoposide
  • GemCarbo (gemcitabine and carboplatin)
  • CAV (cyclophosphamide, doxorubicin and vincristine)

People who have medical conditions that mean they can’t have CAV chemotherapy might have topotecan chemotherapy capsules.

Chemotherapy for advanced non small cell lung cancer

You usually have treatment with either cisplatin or carboplatin combined with one of the following drugs:

  • gemcitabine (Gemzar)
  • paclitaxel (Taxol)
  • vinorelbine (Navelbine)
  • docetaxel (Taxotere)
  • pemetrexed (Alimta)

If you have cisplatin and pemetrexed treatment and your cancer shrinks or stops growing, your specialist might recommend that you continue with pemetrexed treatment on its own. Doctors call this pemetrexed maintenance treatment.

If your cancer continues to grow during chemotherapy your doctor might recommend:

  • docetaxel (Taxotere) chemotherapy if you haven't had it before
  • docetaxel and a targeted cancer drug called nintedanib depending on your type of non small cell lung cancer (NSCLC)
  • changing to another chemotherapy treatment

Your doctor might suggest that you have a different type of targeted cancer drug.

How you have chemotherapy

You usually have the chemotherapy drugs as liquids into your vein. But some drugs are capsules 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.

Taking capsules

You must take your capsules according to the instructions your doctor or pharmacist gives you.

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 specialist or advice line before you stop taking a cancer drug.

When you have it

You usually have chemotherapy every 3 to 4 weeks. Each 3 to 4 week period is called a cycle. You might have between 4 to 6 cycles of chemotherapy.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You’ll sit in a chair for a few hours so it’s a good idea to take newspapers, books or electronic devices to help to pass the time.

You have some types of chemotherapy over a couple of days and stay in a hospital ward. But this is not usual with lung cancer chemotherapy.

Before you start chemotherapy

COVID swab test

Due to coronavirus, you need to have a test to check for coronavirus before you have treatment. The test is called a COVID swab test.

To have the test your nurse takes a sample from the inside of your nose and the back of your throat. They use a long cotton bud to take the sample. Or the sample might be saliva or other fluid. Depending on which test your hospital uses, it can take from 90 minutes to a few days to get a result.

At most hospitals, you have a COVID swab test 48 to 72 hours (up to 3 days) before going for your treatment in the chemotherapy unit.

This means you might have the swab test on the same day that you visit the hospital for blood tests and your doctor’s clinic appointment. If you have treatment weekly or more often, some hospitals will ask you to have the swab test on the day of treatment.

Check with your team about when you’ll have the test as there are some differences between hospitals.

Blood tests

You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your doctors and pharmacists work out your chemotherapy dose based on your blood cell levels, and your weight, height and general health.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

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.

When you go home

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

Dietary or herbal supplements and chemotherapy

Let your doctors know if you take any supplements or if you have been prescribed anything by alternative or complementary therapy practitioners.

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