Treatments for NSCLC by Stage

Stages IA and IB

• Surgery, alone or followed by adjuvantTherapy applied after initial treatment for cancer, especially to suppress secondary tumor formation treatment:
  • 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
  • Osimertinib (Tagrisso®) for patients with EGFR exon 19 deletions or exon 211 L858R mutations, as detected by an FDA-approved test
• NeoadjuvantAdministration of therapeutic agents before a main treatment nivolumab (Opdivo®) in combination with platinum-doublet chemotherapy
• New treatments available through clinical trials

Stages IIA and IIB

• Surgery alone
• Neoadjuvant nivolumab (Opdivo®) in combination with platinum-doublet chemotherapy
• Surgery, followed by chemotherapy with or without radiation therapy
• Surgery, followed by radiation therapy
• Surgery, followed by osimertinib (Tagrisso®) for patients with EGFR exon 19 deletions or exon 21 L858R mutations, as detected by by an FDA-approved test³
• Chemotherapy, followed by surgery
• Radiation therapy for patients who cannot or choose not to have surgery
• New treatments available through clinical trials

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
• 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 adjuvant chemotherapy and postoperative radiation therapy (PORT)
• Surgery followed by osimertinib (Tagrisso®) for patients with EGFR exon 19 deletions or exon 21 L858R mutations, as detected by by an FDA-approved test
• Neoadjuvant nivolumab (Opdivo®) in combination with platinum-doublet chemotherapy 
• 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 or consecutively
• Immunotherapy with durvalumab (Imfinzi®) after chemotherapy and radiation therapy is complete
• Immunotherapy (cemiplimab-rwlc) if also not candidates for definitive chemoradiation and have high PD-L1 expression and no EGFR, ALK, or ROS1 mutations
• Internal radiation therapy or laser surgery as palliative treatments
• 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 as spearate treatments over 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 or laser therapy as palliative care
• Immunotherapy with durvalumab (Imfinzi®) after chemotherapy and radiation is complete
• Immunotherapy (cemiplimab-rwlc) if also not candidates for definitive chemoradiation and have high PD-L1 expression and no EGFR, ALK, or ROS1 mutations
• New treatments available through clinical trials

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 kinase inhibitor if a driver mutation is present
• Targeted therapy with an MTOR inhibitor
• Combination angiogenesis inhibitor and targeted therapy
• Internal radiation therapy for cancer that has not spread to major lymph nodes
• Immunotherapy drugs, alone or in combination
• Combination immunotherapy and chemotherapy
• Combination immunotherapy, chemotherapy, and angiogenesis inhibitor
• Immunotherapy (cemiplimab-rwlc) if also not candidates for definitive chemoradiation and have high PD-L1 expression and no EGFR, ALK, or ROS1 mutations
• 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
• Clinical trials of chemotherap drugs, targeted therapy drugs, immunotherapy drugs, or a combination of these

Recurrent NSCLC

• Chemotherapy
• Immunotherapy drugs, in combination, with 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
• 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 these