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.
NSCLC treatment may involve one or a combination of treatments such as surgery, radiation, chemotherapy, and even immunotherapy. Treatment has changed a lot in recent years because researchers have found many genetic mutations in NSCLC as well as gained new knowledge about how the mutations work. With new therapies that target some of these mutations, there are now more options than ever.
Sometimes a targeted therapy becomes ineffective. That’s when a different drug or combination of a targeted drugs and chemotherapy may be the next step.
These drugs target the EGFR mutation:
- afatinib (Gilotrif)
- gefitinib (Iressa)
- necitumumab (Portrazza)
- erlotinib (Tarceva)
In some cases, targeted therapy stops working because you’ve acquired another mutation. If you’ve had the EGFR mutation, more genetic tests might show that you’ve since developed the T790M mutation.
Osimertinib (Tagrisso) is a newer drug that targets this particular mutation. It’s approved for use in metastatic NSCLC that hasn’t responded 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. NSCLC can be treated with:
- atezolizumab (Tecentriq)
- nivolumab (Opdivo)
- pembrolizumab (Keytruda)
Your doctor will make recommendations based on things like your age, health, and genetic mutations. Personal treatment goals such as impact on your quality of life should also be taken 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. Previous treatments, age, and general health may also be considered.
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.
Your doctor can help you find appropriate clinical trials. For more information on clinical trials, visit the database or ClinicalTrials.gov.
Complementary therapies can help ease symptoms and side effects of treatment. Most won’t hurt you, but some can. Consult your doctor before starting complementary therapies.
Acupuncture is said to help relieve pain and nausea. Since it involves the use of 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 follows proper hygienic practices.
Massage therapy 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 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 also help promote relaxation and reduce anxiety.
Your mind is as important as your body, so you might benefit from creative arts therapy. Whether it’s music, painting, or crafting, these activities can help you relax while providing an artistic outlet. And fun is an essential part of life too.
What you eat impacts your body and your state of mind. A dietitian or nutritional counselor can make sure you’re getting the nourishment you need to be at your best. Talk to 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 the 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.