Lung Cancer (Non-Small Cell)

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Treating Lung Cancer - Non-Small Cell TOPICS

Targeted therapies for non-small cell lung cancer

As researchers have learned more about the changes in lung cancer cells that help them grow, they have developed newer drugs that specifically target these changes. These targeted drugs work differently from standard chemotherapy (chemo) drugs. They sometimes work when chemo drugs don’t, and they often have different (and less severe) side effects. At this time, they are most often used for advanced lung cancers, either along with chemo or by themselves.

Drugs that target tumor blood vessel growth (angiogenesis)

For tumors to grow, they must form new blood vessels to keep them nourished. This process is called angiogenesis. Some targeted drugs, called angiogenesis inhibitors, block this new blood vessel growth.

Bevacizumab (Avastin®) is an angiogenesis inhibitor used to treat advanced non-small cell lung cancer. It is a monoclonal antibody (a man-made version of a specific immune system protein) that targets vascular endothelial growth factor (VEGF), a protein that helps new blood vessels to form.

This drug is often used with chemo for a time. Then if the cancer responds, the chemo may be stopped and the bevacizumab is given by itself until the cancer starts growing again.

The possible side effects of this drug are different from (and may add to) those of chemotherapy drugs. Some of these effects can be serious.

Bevacizumab can cause serious bleeding, which limits its use to some extent. It is not used in patients who are coughing up blood. Most current guidelines do not recommend using bevacizumab in patients with the squamous cell type of lung cancer, because it may lead to serious bleeding in the lungs.

Drugs that target EGFR

Epidermal growth factor receptor (EGFR) is a protein found on the surface of cells. It normally helps the cells to grow and divide. Some NSCLC cells have too much EGFR, which causes them to grow faster. Drugs that target EGFR used to treat non-small cell lung cancer (NSCLC) include:

Erlotinib and afatinib block the signal from EGFR that tells cells to grow. They can be used alone (without chemo) as the first treatment for advanced NSCLCs that have certain mutations in the EGFR gene. These are more common in women and people who haven’t smoked. Erlotinib is also used for advanced NSCLC without those mutations if chemo isn’t working. Both erlotinib and afatinib are pills.

Common side effects of these drugs include:

  • Skin problems
  • Diarrhea
  • Mouth sores
  • Loss of appetite

Skin problems can include an acne-like rash on the face and chest, which in some cases can lead to skin infections.

For more information about side effects of either of these drugs, see our Guide to Cancer Drugs.

For more detailed information on the skin problems that can result from anti-EGFR drugs, see our document Targeted Therapy.

Drugs that target the ALK gene

About 5% of NSCLCs have been found to have a rearrangement in a gene called ALK. This change is most often seen in non-smokers (or light smokers) who have the adenocarcinoma subtype of NSCLC. The ALK gene rearrangement produces an abnormal ALK protein that causes the cells to grow and spread. Drugs that target ALK include:

These drugs block the abnormal ALK protein and can shrink tumors in patients whose lung cancers have the ALK gene change. Although they can help after chemo has stopped working, they are often used instead of chemo in people whose cancers have the ALK gene rearrangement.

Both of these drugs are pills. Common side effects include:

Some side effects can be severe, such as low white blood cell counts, lung inflammation, liver damage, and heart rhythm problems.

For more information about side effects of either of these drugs, see our Guide to Cancer Drugs.

Last Medical Review: 08/15/2014
Last Revised: 11/10/2014