When it comes to managing non-small cell lung cancer (NSCLC), the most important thing is to make sure your treatment plan is working.
Because of various mutations in NSCLC, it’s not about finding the best treatment, but finding the best treatment for you. Just because your current treatment has stopped working doesn’t mean you’re out of options.
Here’s what you need to know about treatment options, drug trials, and alternative therapies, as well as what to ask your doctor when your treatment has become ineffective.
Treatment has changed a lot in recent years. Researchers have found many genetic mutations in NSCLC and have learned more about how the mutations work. With new therapies that target some of these mutations, you now have more options than ever.
Sometimes a targeted therapy becomes ineffective. That’s when a different drug, or a combination of targeted drugs and chemotherapy, may be the next step.
These drugs target the EGFR mutation:
- afatinib (Gilotrif)
- gefitinib (Iressa)
- necitumumab (Portrazza)
- erlotinib (Tarceva)
- mobocertinib (Exkivity)
Osimertinib (Tagrisso) is a newer drug that targets this particular mutation. It’s approved for use in metastatic NSCLC that hasn’t responded to — or has stopped responding to — drugs that target the EGFR mutation.
Drugs that target the ALK mutation include:
- alectinib (Alecensa)
- brigatinib (Alunbrig)
- ceritinib (Zykadia)
- crizotinib (Xalkori), which can also be used for the ROS1 mutation
Other targeted therapies include:
- dabrafenib (Tafinlar) for the BRAF mutation
- trametinib (Mekinist) for the MEK mutation
- bevacizumab (Avastin) and ramucirumab (Cyramza) to prevent tumors from forming new blood vessels
Immunotherapy is a way to get your immune system to fight cancer more effectively. For example, according to the
- atezolizumab (Tecentriq)
- nivolumab (Opdivo)
- pembrolizumab (Keytruda)
- cemiplimab (Libtayo)
- durvalumab (Imfinzi)
The CLTA-4 inhibitor ipilimumab (Yervoy) is another immune checkpoint inhibitor that can treat NSCLC. It can be used along with nivolumab or chemotherapy.
Your doctor will make recommendations based on things like your age, your health, and any genetic mutations involved in your diagnosis. They should also take your personal treatment goals (such as impact on your quality of life) into account.
Clinical trials are designed to test the safety and effectiveness of experimental treatments. Trials usually have strict criteria based on cancer type and stage. Other considerations may include the previous treatments, age, and general health of participants.
By being a part of a clinical trial, you may gain access to innovative and experimental drugs you couldn’t get anywhere else. Because they test different treatments for various types and stages of NSCLC, you might likely be eligible no matter where you are in your treatment.
Complementary therapies can help ease symptoms and side effects of treatment. Most won’t hurt you, but some can. Consult with your doctor before starting complementary therapies.
- Acupuncture. Acupuncture is said to help relieve pain and nausea. Since this therapy involves needles, you shouldn’t consider it if you take blood thinners or have low blood counts. Always check that the acupuncturist is trained and licensed, and that they follow proper hygienic practices.
- Massage therapy. Massage can help you relax and relieve anxiety and pain. Some massage therapists are trained to work with people who have cancer. Be sure to mention where you have tumors, surgical wounds, or pain.
- Yoga and tai chi. These exercises combine deep breathing with gentle movements to promote the mind-body connection. It might help your overall sense of well-being so you can relax and get a better night’s sleep. Avoid movements and poses that cause pain or make it harder to breathe.
- Meditation and hypnosis. These can also help to promote relaxation and reduce anxiety.
- Creative arts therapy. Creative arts therapy can help you relax while providing an artistic outlet. Whether through music, painting, or crafting, dabbling in the arts can have relaxation benefits.
- Meal therapy. Meal therapy may help enhance your overall health, improve your energy levels, and give you more strength during your treatment. While there isn’t a “best diet” for people with NSCLC, work together with your doctor to choose foods that may help with your weight loss, nausea, fatigue, dehydration, or lack of appetite.
What you eat can impact your body and your state of mind. A dietitian or nutritional counselor can help ensure you’re getting the nourishment you need to be at your best. Talk with your doctor before taking new dietary supplements or herbal remedies, as they can react with medications or interfere with treatment.
A good doctor appreciates that you want to be an active participant in your care routine. All of your concerns are worthy of discussion.
Ask lots of questions. If you don’t fully understand an answer, it’s perfectly reasonable to ask for clarification. It’s also a good idea to write your questions down in advance, take notes during doctor visits, or bring someone with you to help.
Here are a few questions to get the conversation started:
- Why isn’t this treatment working?
- What’s my best option now and why?
- What are the potential benefits and risks of this therapy?
- How will it impact my day-to-day life?
- What complementary therapies are safe for me?
- Are there any clinical trials I should consider?
There may come a point when you no longer wish to treat your cancer. It’s important that you communicate this so you can get input from your doctor.
If you do choose to stop cancer treatment, you don’t have to stop all forms of therapy. Your doctor can provide information about palliative care, including:
- pain management
- respiratory therapy
- complementary and alternative therapies
- in-home and hospice care
- local support groups
The bottom line is that treatment for NSCLC is different for everybody.
If your current therapy has stopped working, it doesn’t necessarily mean that you’re out of options. It does mean that it’s time to have an in-depth discussion with your doctor about the next steps, your outlook, and how it will impact your quality of life.