Treatment Options for Non-Small Cell Lung Cancer by Stage

The treatment options for non-small cell lung cancer depend in part on where the lung cancer is located within the lungs and whether the cancer has spread or not. Below are the various options for each stage of primary lung cancer and for lung cancer that has recurred.  

Stages IA and IB

  • Surgery, alone or followed by:
    • Radiation therapy
    • Chemotherapy, if high risk for recurrenceLung cancer that has come back after a period of time during which the cancer could not be detected
  • New treatments available through clinical trials:
    • Chemotherapy or radiation therapy following surgery
    • Treatment given through an endoscopeA thin, tube-like instrument used to look at tissues inside the body, such as photodynamic therapy (PDT)Treatment with drugs that become active when exposed to light1

Stage IIA

  • Surgery
  • Surgery, followed by chemotherapy with or without radiation therapy
  • Surgery, followed by radiation therapy
  • Chemotherapy, followed by surgery
  • Radiation therapy for patients who cannot or choose not to have surgery
  • New treatments available through clinical trials:
    • Surgery followed by radiation therapy
    • Immunotherapy1

Stage IIB

  • Surgery
  • Surgery, followed by chemotherapy with or without radiation therapy
  • Surgery, followed by radiation therapy
  • Chemotherapy, followed by surgery
  • Radiation therapy for patients who cannot or choose not to have surgery
  • New treatments available through clinical trials:
    • Surgery followed by radiation therapy
    • Immunotherapy

Non-small cell lung cancer of the superior sulcus, often called a Pancoast tumorA type of lung cancer that begins in the upper part of a lung and spreads to nearby tissues such as the ribs and vertebrae, begins in the upper part of the lung and spreads to nearby tissues such as the ribs and vertebrae. Treatment of Pancoast tumors may include the following:

  • Radiation therapy alone
  • Radiation therapy followed by surgery
  • Chemotherapy and radiation therapy given as separate treatments over the same period of time, followed by surgery
  • Surgery alone
  • A clinical trial of new combinations of treatments

Stage IIIA

If the patient has lung cancer that is resectableAble to be removed by surgery, the following may be treatment options:

  • Surgery followed by adjuvantCancer treatment given after the primary treatment in order to kill unseen cancer cells or to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, or biological therapy.chemotherapy and postoperative radiation therapy (PORT) chemotherapy and postoperative radiation therapy (PORT)
  • NeoadjuvantTreatment given prior to the main treatment in order to shrink a tumor. Examples of neoadjuvant therapy include chemotherapy and/or radiation therapy prior to surgery. chemotherapy followed by surgery and PORT
  • New treatments available through clinical trials, including new types or combinations of treatments

If the patient has lung cancer that cannot be removed by surgery, options include:

  • Chemotherapy and radiation therapy given as separate treatments over the same period of time
  • Immunotherapy with durvalumab (Imfinzi®) after chemotherapy and radiation therapy is complete
  • New treatments available through clinical trials, including new types or combinations of treatments

Supportive care (also called palliative careCare given to improve the quality of life of patients who have a serious or life-threatening disease) is also helpful for signs and symptoms including cough, shortness of breath, and chest pain. Read more about palliative care.

Non-small cell lung cancer of the superior sulcus, often called a Pancoast tumor, begins in the upper part of the lung and speads to nearby tissues such as the ribs and vertebrae. Treatment of Pancoast tumors may include the following:

  • Radiation therapy alone
  • Radiation therapy followed by surgery
  • Chemotherapy and radiation therapy given as separate treatments over the same period of time, followed by surgery
  • Surgery alone
  • Immunotherapy with durvalumab (Imfinzi®) after chemotherapy and radiation is complete
  • A clinical trial of new combinations of treatments1

Stages IIIB and IIIC

  • External beam radiation therapy
  • Chemotherapy and external beam radiation therapy given one after the other or combined at the same time
  • Targeted therapy with a tyrosine kinase inhibitorA type of targeted therapy that blocks the action of enzymes called tyrosine kinases in order to keep cancer cells from growing if a driver mutationA change to the DNA of cancerous cells that is considered to have been a cause of the development of the cancer and has helped the cancer cell to grow  is present
  • Internal radiation therapy as palliative care
  • Immunotherapy with durvalumab (Imfinzi®) after chemotherapy and radiation is complete
  • New treatments available through clinical trials1

Supportive (palliative) care is also helpful for signs and symptoms including cough, shortness of breath, and chest pain. Read more about palliative care.

Stages IVA and IVB

  • Combination chemotherapy
  • Combination chemotherapy, followed by maintenance therapyTreatment that is given to help keep cancer from coming back after it has disappeared following the initial therapy with an anticancer drug to help keep the cancer from progressing
  • Combination chemotherapy and targeted therapy with a monoclonal antibodyA type of protein made in the laboratory that can bind to substances in the body, including cancer cells
  • Targeted therapy with a tyrosine kinase inhibitor if a driver mutation is present
  • Internal radiation therapy for cancer that has not spread to major lymph nodes
  • Immunotherapy drugs
  • Combination immunotherapy and chemotherapy
  • Clinical trials of chemotherapy drugs, targeted therapy drugs, immunotherapy drugs, or a combination of these
  • Treatments specific for bone and brain metastasis, such as bisphosphonates (for bone metastasis) or brain radiation or surgery (for brain metastasis)
  • External or internal radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life1

Recurrent NSCLC

  • Chemotherapy
  • Targeted therapy
  • Laser therapy or internal radiation therapy
  • Surgery to remove a very small amount of cancer that has spread to the brain
  • External beam radiation therapy as palliative therapy, to relieve pain and other symptoms and improve the quality of life
  • Stereotactic radiosurgeryA type of stereotactic body radiation therapy that is given in a single large dose of radiation to a tumor
  • Clinical trials of chemotherapy drugs, targeted therapy drugs, immunotherapy drugs, or a combination of these1,2
  •  

Updated April 5, 2018


References

  1. NCCN Guidelines for Patients®: Lung Cancer – Non-Small Cell Lung Cancer. The National Comprehensive Care Network website. https://NCCN.org/patients/guidelines/content/PDF/nsclc.pdf. Posted November 30, 2017. Accessed April 5, 2018. 
  2.  Non-Small Cell Lung Cancer Treatment (PDQ®)—Patient Version. National Cancer Institute website. https://www.cancer.gov/types/lung/patient/non-small-cell-lung-treatment-pdq#section/_231. Updated March 30, 2018. Accessed April 5, 2018.

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