About targeted cancer drugs
Targeted cancer drugs work by ‘targeting’ those differences that help a cancer cell to survive and grow. Find out about targeted cancer drugs, the different types and when you have them for lung cancer.
What are targeted cancer drugs?
Cancer cells have changes in their genes (DNA) that make them different from normal cells. These changes mean that they behave differently. Cancer cells can grow faster than normal cells and sometimes spread. Targeted cancer drugs work by ‘targeting’ those differences that a cancer cell has.
Targeted drugs work in different ways. For example, they can:
- stop cancer cells from dividing and growing
- encourage the immune system to attack cancer cells
- stop cancers from growing blood vessels
You might hear some targeted drugs called biological therapies.
When you might have these drugs
You might have targeted cancer drug treatment for non small cell lung cancer that has spread outside the lung or to other parts of the body.
You might have some drugs as part of a clinical trial or together with chemotherapy.
The type of targeted drug you have depends on the type of proteins on your cancer cells. Doctors check your cancer cells to see which proteins they have before you start the treatment.
Types of targeted drugs
EGFR gene changes
These drugs work by blocking proteins on cancer cells called epidermal growth factor receptors (EGFR).
You might have one of these drugs if you have advanced non small cell lung cancer and your cancer cells have changes (mutations) in the EGF receptors.
- erlotinib (Tarceva)
- gefitinib (Iressa)
- afatinib (Giotrif)
- osimertinib (Tagrisso)
Your doctor will check your cancer cells to see if this is the case. Cancers that have these changes 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.
Tyrosine kinase inhibitors
Tyrosine kinase inhibitors work by blocking an enzyme called anaplastic lymphoma kinase (ALK). They are used to treat some people with advanced non small cell lung cancer (NSCLC). The drugs that may be given include:
- Crizotinib (Xalkori)
- Ceritinib (Zykadia)
- Alectinib (Alecensa)
- Brigatinib (Alunbrig)
- Lorlatinib (Lorviqua)
These drugs only work in cancer cells that have an overactive version of ALK. So your doctor will check your cancer cells to see if this is the case. About 5 in 100 people (5%) with NSCLC have this. It is called ALK positive disease.
The National Institute for Health and Care Excellence (NICE) and the Scottish Medicines Consortium (SMC) have recommended that people have ceritinib if they have already had treatment with crizotinib. The NICE guidance applies to England and Wales.
Alectinib is currently available through the Cancer Drugs Fund as a first treatment for advanced ALK positive NSCLC.
Brigatinib (Alunbrig) is available on the NHS. You might be offered it if you have ALK positive NSCLC and have previously been treated with crizotinib.
Lorlatinib (Lorviqua) is also available. You may have it if you have already had treatment with either:
- alectinib or ceritinib
- crizotinib and at least one other of these types of drugs (ALK tyrosine kinase inhibitors)
In Scotland, you may also be able to have lorlatinib if you have not already had treatment with any of the similar drugs (ALK inhibitors).
Nintedanib (Vargatef)
Nintedanib is a cancer growth blocker. It blocks protein kinases on the cancer cells. Nintedanib blocks a number of these proteins and is called a multi kinase inhibitor. It also stops the cancer cells growing their own blood vessels, which the cells need to be able to grow.
Doctors use nintedanib for a type of non small cell lung cancer (NSCLC) called adenocarcinoma. It is for people who have already had one type of chemotherapy and whose cancer has grown back or spread.
Nivolumab (Opdivo)
Nivolumab is a type of immunotherapy that stimulates the body’s immune system to fight cancer cells.
Nivolumab is licensed to treat adults with non small cell lung cancer (NSCLC) who have already had chemotherapy. It is for people whose disease has spread outside of the lung into the surrounding tissue (locally advanced), or to other parts of the body (advanced).
Pembrolizumab (Keytruda)
Pembrolizumab is a type of immunotherapy. Your doctor might recommend you have pembrolizumab if you have advanced non small cell lung cancer (NSCLC) and your cancer cells have particular proteins. It targets and blocks a protein called PD-1 on the surface of certain immune cells called T-cells. Blocking the PD-1 protein triggers the T-cells to find and kill cancer cells.
You might have pembrolizumab on its own, or possibly with chemotherapy drugs.
Atezolizumab (Tecentriq)
Atezolizumab is a type of immunotherapy. It works by blocking a protein called PD-L1 that stops the immune system from working properly and attacking cancer cells.
You might have treatment with Atezolizumab if you have NSCLC that has spread to another part of your body and your cancer cells have the PD-L1 protein.
Sotarasib (Lumakras)
Sotorasib is a targeted drug. It blocks an abnormal protein made by an altered (mutated) gene called K-RAS. Some lung cancers have changes (mutations) in this gene. The K-RAS gene is important in controlling cell growth. Changes to this gene can lead to cells growing and dividing out of control to form cancers.
You might have Sotorasib if you have previously had treatment for locally advanced or advanced non small cell lung cancer. And if your cancer cells have changes (mutations) in the K-RAS gene. Your doctor will check your cancer cells to see if this is the case.
Sotorasib is currently available through the Cancer Drugs Fund. In Scotland, the SMC has accepted is use on the NHS in the short term. Doctors are still collecting information about how well this drug works, particularly in comparison to other cancer drugs, and its side effects.
Selpercatinib
Selpercatinib is a new drug that is available through the Cancer Drugs Fund for advanced NSCLC that has a change in a 
called RET. These gene changes make an abnormal amount of RET proteins which help cancer cells to grow. Selpercatinib blocks these proteins.
It is for people that have already had treatment with an immunotherapy (such as pembrolizumab) or chemotherapy (such as cisplatin), or both. As selpercatinib is a new drug, doctors are still collecting more evidence on how well this treatment works.
Selpercatinib is currently not routinely available on the NHS in Scotland.
Tepotinib
Tepotinib is another type of cancer growth blocker. It may be an option for some people with NSCLC. It is a new drug for cancers that have a change in the MET factor gene.
It is not available on the NHS in Scotland at the moment. But the Scottish Medicines Consortium (SMC) are looking at it.
Having targeted cancer drug treatment
You have your treatment as tablets or capsules, or through a tube into your bloodstream. This depends on the type of drug you have.
Tablets or capsules
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.
Into the bloodstream
You have some of these drugs through a tube into your bloodstream. A nurse puts a small tube into a vein in your hand or arm and connects the drip to it.
Or you might have a central line. This is a long plastic tube that gives the drug into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment.
Before you start the treatment
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. If you are having chemotherapy alongside the targeted drugs you also have blood tests before each round or cycle of chemotherapy.
Side effects
The side effects you have depend on:
- which drug you have
- whether you have it alone or with other drugs
- the amount of drug you have (the dose)
- your general health
Everyone is different and the side effects vary from person to person. You might have a few side effects. And they may be mild or more severe.
A side effect may get better or worse during your course of treatment. Or more side effects may develop as the treatment goes on.
For more information about the side effects of your treatment, go to the individual drug pages.
When you go home
Treatment with targeted drugs can be difficult to cope with for some people. Your nurse will give you a number to call (advice line) if you have any problems at home.
If you also have chemotherapy
If you are having chemotherapy as well as a targeted cancer drug, you usually have the chemotherapy into your vein through a drip. You have this in the cancer day clinic every few weeks.
Chemotherapy drugs that you might have in combination with targeted drugs include:
- cisplatin
- carboplatin
- docetaxel
Targeted cancer drugs in clinical trials
You might have one of the current targeted cancer drugs or a new drug as part of a clinical trial. In some trials you have the drugs in combination with chemotherapy.
