Stage Four Lung Cancer: What To Ask Your Doctor
- Should I have genetic or molecular testing?
- Do I have any genetic mutation that would change the course of my treatment?
- Am I eligible for immunotherapy? Am I more, or less, likely to respond to this treatment?
- How aggressively should we treat my cancer?
- Is there a clinical trial that could be relevant for me?
In the past, chemotherapy–which attempts to kill all fast-growing cells in the body–was considered the treatment standard for stage four lung cancer, but treatment methodologies are changing. These advances involve testing your cancer for the presence of genetic mutations, or molecular features, which might be targets for relatively new medications. For some people, these medications are extending life in remarkable ways.
- With advanced lung cancer, you may be eligible for a type of immunotherapy called a checkpoint inhibitor. Your eligibility is in part determined by testing your cancer for the presence of a protein called PD-L1. Widely used checkpoint inhibitors include the drugs Keytruda (pembrolizumab), Opdivo (nivolumab), Tecentriq (atezolizumab), Yervoy (ipilimumab) and Libtayo (cemiplimab-rwlc). You can watch and read more about how checkpoint inhibitors work here. A lot of research is going on with these drugs, and it can take time to make it into the doctor’s office, but here are the official treatment guidelines for what’s called “standard of care.” These are created by a consortium of cancer centers called the National Comprehensive Cancer Network.
- Check-point inhibitors are sometimes used in place of chemotherapy, along with chemo, or after you’ve tried chemo.
- It is important to understand that these drugs do not work for everyone and can sometimes stop working after a period of time.
Targeted Therapies, Or Precision Medicine
Many researchers believe that precision medicine, or attempting to match your treatment to your tumor’s individual biology and characteristics, is the way forward.
- Getting genetic and molecular testing is, as we said, the key first step to determining if you are eligible for a targeted therapy
- Do you have a genetic mutation such as KRAS, ALK, or EGFR? Your doctor should be looking for whether your cancer might be treated with the growing number of medicines that more precisely target a specific mutation. Other examples of targeted therapies include MET, RET and ROS1 inhibitors.
- For example, if your cancer is over-expressing epidermal growth factor receptor (EGFR)–a protein that makes cells grow and divide–drugs blocking EGFR may be used.
- Targeted therapy seeks out very specific cancer cells and leaves the healthy cells alone. Chemotherapy tends to cause a lot of collateral damage because it kills all fast-growing cells–both healthy and cancerous.