As researchers have learned more about the changes in non-small cell lung cancer (NSCLC) cells that help them grow, they have developed newer drugs to specifically target these changes. 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 need to 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 used to treat advanced NSCLC. 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 given by itself until the cancer starts growing again.
- Ramucirumab (Cyramza) can also be used to treat advanced NSCLC. VEGF has to bind to cell proteins called receptors to act. This drug is a monoclonal antibody that targets a VEGF receptor. This helps stop the formation of new blood vessels. This drug is most often given after another treatment stops working. It is often combined with chemo.
Common side effects of these drugs include:
- High blood pressure
- Low white blood cell counts (with increased risk of infections)
- Mouth sores
- Loss of appetite
Rare but possibly serious side effects can include blood clots, severe bleeding, holes (called perforations) forming in the intestine, heart problems, and slow wound healing. If a hole forms in the intestine it can lead to severe infection and may require surgery to correct.
Because of the risks of bleeding, these drugs typically aren’t used in people who are coughing up blood or who are taking drugs called blood thinners. The risk of serious bleeding in the lungs is higher in patients with the squamous cell type of NSCLC, which is why most current guidelines do not recommend using bevacizumab in people with this type of lung cancer.
Drugs that target cells with EGFR changes
Epidermal growth factor receptor (EGFR) is a protein on the surface of cells. It normally helps the cells grow and divide. Some NSCLC cells have too much EGFR, which makes them grow faster. Drugs called EGFR inhibitors can block the signal from EGFR that tells the cells to grow. Some of these drugs can be used to treat NSCLC.
EGFR inhibitors used in NSCLC with EGFR gene mutations
- Erlotinib (Tarceva)
- Afatinib (Gilotrif)
- Gefitinib (Iressa)
These drugs 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 can also be used for advanced NSCLC without these mutations if chemo isn’t working. All of these medicines are taken as pills.
EGFR inhibitors that also target cells with the T790M mutation
EGFR inhibitors can often shrink tumors for several months or more. But eventually these drugs stop working for most people, usually because the cancer cells develop another mutation in the EGFR gene. One such mutation is known as T790M. But some newer EGFR inhibitors also work against cells with the T790M mutation, including osimertinib (Tagrisso).
Doctors now commonly get another tumor biopsy when EGFR inhibitors have stopped working to see if the patient has developed the T790M mutation.
EGFR inhibitors used for squamous cell NSCLC
Necitumumab (Portrazza) is a monoclonal antibody (a man-made version of an immune system protein) that targets EGFR. It can be used along with chemotherapy as the first treatment in people with advanced squamous cell NSCLC. This drug is given as an infusion into a vein (IV).
Common side effects of all EGFR inhibitors include:
- Skin problems
- 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 detailed information on the skin problems that can result from anti-EGFR drugs, see Targeted Therapy.
These drugs can also cause more serious, but less common, side effects. For example, necitumumab can lower the levels of certain minerals in the blood, which can affect the heart rhythm and in some cases might be life-threatening.
Drugs that target cells with ALK gene changes
About 5% of NSCLCs 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 the abnormal ALK protein include:
- Crizotinib (Xalkori)
- Ceritinib (Zykadia)
- Alectinib (Alecensa)
These drugs can often shrink tumors in people 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.
These drugs also seem to be useful in treating people whose cancers have changes in the ROS1 gene.
These drugs are taken as pills.
Common side effects of ALK inhibitors include:
Other side effects are also possible. Some side effects can be severe, such as low white blood cell counts, lung inflammation, liver damage, and heart rhythm problems.
Last Revised: 03/11/2016