Chemotherapy for Lung Cancer

January 24, 2025

This page was reviewed under our medical and editorial policy by Jyoti Malhotra, M.D., M.P.H., associate professor, Department of Medical Oncology & Therapeutics Research, City of Hope^® Orange County Lennar Foundation Cancer Center; and Jae Y. Kim, M.D., associate professor, Division of Thoracic Surgery, Department of Surgery, City of Hope Cancer Center Duarte

Patients with lung cancer may undergo chemotherapy as part of their treatment plan. Chemotherapy, sometimes called chemo, uses drugs to destroy lung cancer cells. It is often combined with other treatment methods.

This guide to chemotherapy treatment for lung cancer is designed to help patients learn more.

How Is Chemotherapy Used in Treating Lung Cancer?

Each patient is different. Chemotherapy treatment recommendations are based on many factors, such as the stage of the cancer and the patient’s general health. To treat lung cancer, chemotherapy may have a role before or after surgery. For some people with lung cancer, it is recommended on its own without surgery or other therapies, or it may at times be combined with other treatments, such as radiation therapy or immunotherapy for lung cancer.

The way chemotherapy is used is also dependent on whether the patient has small cell or non-small cell lung cancer.

Before Surgery (Neoadjuvant)

Neoadjuvant chemotherapy combined with immunotherapy may be used prior to surgery to improve the chances of curing the patient’s lung cancer, primarily by treating micrometastatic disease (small groups of cancer cells).

Neoadjuvant chemotherapy and immunotherapy may be used on non-small cell lung cancer types. Small cell lung cancers are usually not treated surgically.

Sometimes, neoadjuvant chemotherapy is also combined with radiation therapy for lung cancer, as both treatments may work together to shrink the non-small cell tumor before surgery.

After Surgery (Adjuvant)

Adjuvant chemotherapy may be given after surgery for non-small cell lung cancer patients. It is sometimes combined with radiation therapy, and its purpose is to destroy any cancer cells that may be left in the body following surgery. This reduces the risk of the cancer returning later on. Adjuvant immunotherapy may also be given to patients for a year after surgery, and the care team may recommend targeted therapy as an adjuvant therapy for lung cancers with specific molecular features.

Primary or Combination Treatment

Chemotherapy may also be used as a primary treatment or combined with other treatment types. This is known as combination treatment.

Small cell lung cancers may be treated with chemotherapy combined with either radiation therapy or immunotherapy, depending on the cancer’s stage.

Non-small cell lung cancers that have grown into nearby structures (locally advanced) may also be treated with a combination of chemotherapy and radiation therapy.

Chemotherapy may be used as a standalone treatment for advanced-stage small cell and non-small cell cancers that have spread beyond the lungs into other areas of the body.

How Is Chemotherapy Given?

Chemotherapy may be administered in several ways.

Orally: The chemotherapy is taken by mouth, usually as a pill.

Intravenously: In this method, chemotherapy medication is given through an IV, directly into the bloodstream. A catheter, which is a small plastic tube, is inserted into a vein via a needle and is the vessel for putting the chemotherapy medication into the bloodstream.

Catheters are used for intravenous chemotherapy in several ways.

• Infusion: A chemotherapy solution is slowly infused into the patient, through tubing attached to the catheter. This may take up to several hours.
• IV push: Chemotherapy medication is injected into the catheter via syringe. This typically takes a few minutes.
• Continuous infusion: Electronic pumps slowly release medication into the body over a set time period, which may be several days.

IT chemotherapy, another method, is used to deliver medication directly into the spinal fluid. It may be used if lung cancer has spread into the brain. IT chemotherapy may be administered using a needle inserted near the spine. Or, a port called an Ommaya reservoir may be surgically placed on the head. A port is a device implanted under the skin, used with a catheter, to make it easier for regular administration of chemotherapy drugs. This implantation is usually performed by an interventional radiologist.

Chemotherapy is given in cycles. This means a patient receives treatment regularly for a set period of time and then takes a break before restarting the cycle. The length of each cycle may vary, depending on the type of chemotherapy being given.

When treating lung cancer, chemotherapy cycles are often three or four weeks for both small and non-small cell lung cancer types. A patient with early-stage disease may undergo four to six cycles. This means chemotherapy for lung cancer may last several months. Patients with advanced non-small cell lung cancer may receive chemotherapy for much longer, or until the disease becomes resistant to it.

What to Expect From Chemotherapy

Before beginning chemotherapy, the patient’s care team reviews the process and helps him or her understand what to expect.

If chemotherapy is given intravenously or intrathecally, it is usually given in an infusion center in a hospital or outpatient setting. Patients won’t need to stay overnight.

Each day, treatment may take anywhere from a few minutes to a few hours, so patients may wish to bring along food, a book or an electronic device. Patients are monitored during and after therapy to ensure they are feeling well and able to travel home.

The care team will also provide patients with guidelines on self-care or any special precautions to take following their treatment.

Chemo Drugs for Lung Cancer

A variety of chemotherapy drugs are used for lung cancer, and often two or more drugs are combined during treatment.

These are some of the chemotherapy medications used for both small cell and non-small cell lung cancers:

• Carboplatin
• Cisplatin
• Taxol^® (paclitaxel)
• Taxotere^® (docetaxel)
• Navelbine^® (vinorelbine)
• Gemzar^® (gemcitabine)

Chemotherapy drugs specific to small cell lung cancer include:

• A combination of carboplatin and VP-16® (etoposide) or cisplatin and VP-16^® (etoposide)
• Zepzelca^® (lurbinectedin)
• Hycamtin^® (topotecan)
• Camptosar^® (irinotecan)
• Temodar^® (temozolomide)

Chemotherapy drugs specific to non-small cell lung cancer include:

• Alimta^® (pemetrexed)
• VP-16^® (etoposide)
• Abraxane^® (albumin-bound paclitaxel)

Side Effects

Chemotherapy may cause side effects. However, not everyone experiences the same side effects. They vary based on the type of treatment, its length and the type of medication used. Side effects may be temporary or longer lasting.

Although side effects may be unpleasant, the patient’s care team assists with ways to manage the discomfort.

The most common side effects associated with lung cancer chemotherapy include the following.

Nausea: Feeling nauseated and vomiting may occur following treatment.

Weight loss: Chemotherapy may lead to a loss of appetite, resulting in weight loss.

Hair loss: Chemotherapy may cause hair to become thinner or fall out completely. However, this is temporary, and hair almost always grows back after treatment is finished.

Mouth sores: Some chemotherapy treatments may cause mouth sores, leading to redness, swelling or discomfort in the mouth.

Bowel changes: Constipation or diarrhea may occur as a result of chemotherapy.

Low white and red blood cell counts: These blood cell count changes may cause fatigue, an increased risk of infection, skin bruising or increased bleeding.

It is possible that some medication types may lead to long-term nerve or kidney damage. The patient’s care team will let them know more about their risk and will take steps to reduce it.