Which Medications Treat Non-Small Cell Lung Cancer?

Living with lung cancer can be an intimidating thought. But it’s a shared reality for millions of people around the world. If this diagnosis has also crept its way into your or a loved one’s life, you’re not alone in considering treatment options. 

This is especially true if a diagnosis includes non-small cell lung cancer (NSCLC) — it’s the most common form of lung cancer. Thankfully, there are now many ways to treat NSCLC. This includes surgery, radiation therapy, and/or medications. Your cancer specialist may decide that one, many, or all of these choices could be helpful for your situation. 

However, not everyone who has NSCLC gets the same treatment. The best treatment for you depends on your cancer stage and other tumor (cancer) traits that you may have. But if your treatment plan includes medications, your cancer specialist has a lot of options to choose from. 

Here, we'll list out and briefly describe different medications used to treat NSCLC.

What types of medications treat non-small cell lung cancer?

Medications for NSCLC fall into three main buckets — chemotherapy, immunotherapy, and targeted therapy. Let’s dive into each one.

1. Chemotherapy: Chemotherapy medications are anti-cancer treatments that kill cancer cells. But they can also harm healthy cells. Chemotherapy is usually part of the treatment strategy for almost all stages of NSCLC. 

2. Immunotherapy: Cancer cells can sometimes hide from your body’s immune system. Immunotherapy is a type of targeted cancer treatment that can improve your immune system's ability to spot cancer cells.

3. Targeted therapy: Targeted therapy medications work by finding specific molecules or genes that are involved in the growth and spread of cancer. These treatments can “target” these changes. 

Why are there so many mutations with lung cancer?

NSCLC has many traits that can differ between people, such as cell type and abnormal cell changes called biomarkers. Biomarkers are characteristics of your cancer that help define what it looks like. They may include changes (mutations) in genes, proteins, or other chemicals in your body. 

These changes are important because they can affect how well certain cancer treatments may work for you. In other words, based on your biomarkers, one treatment might be ideal for you. But it may not be a good choice for someone else if they have different ones. 

In general, there are two groups of biomarkers to be aware of — driver mutations and PD-L1.

Driver mutations

Driver mutations can cause healthy cells in your body to become cancer cells. They also encourage cancer growth. Your cancer specialist can test your cancer to see if it has any of these mutations. 

The world of genetics is complicated, so driver mutations have complex names. Examples include EGFR mutations, ALK rearrangement, BRAF V600E mutations, and many more.

PD-L1

PD-L1 is a protein found on the surface of many cells, especially cancer cells. PD-L1 stops T cells in your immune system from recognizing and killing cancer cells. This allows cancer cells to "hide" and continue growing.

If possible, NSCLC tumor tissue should also be tested for biomarkers like PD-L1. If your lung cancer has a driver mutation or PD-L1, then targeted therapy or immunotherapy medications may be an option for you.

But, keep in mind that not all lung cancers have a driver mutation or PD-L1 proteins. In these cases, your best medication options would often include chemotherapy. 

Chemotherapy medications for non-small cell lung cancer

Chemotherapy for NSCLC usually includes a platinum medication — like cisplatin or carboplatin — plus another chemotherapy medication. This is called “platinum-doublet” chemotherapy. Platinum-doublet chemotherapy is often combined with surgery and/or radiation therapy to treat early-stage and locally advanced forms of NSCLC. 

Examples of platinum-doublet chemotherapy combinations include:

• Cisplatin (or carboplatin) plus pemetrexed

• Carboplatin plus paclitaxel

• Cisplatin (or carboplatin) plus gemcitabine

• Cisplatin plus docetaxel

• Cisplatin plus etoposide

• Cisplatin plus vinorelbine

People with more advanced lung cancer may be treated with only one chemotherapy medication. This is especially true if you’re an older adult or are considered to be in poor health. This helps you tolerate the treatment better. Some examples of single chemotherapy include docetaxel, nab-paclitaxel (Abraxane), or gemcitabine.

But for many, such as those with advanced or metastatic lung cancer, an immunotherapy or targeted therapy medication may also be used. We’ll discuss these next.

Immunotherapy medications for non-small cell lung cancer

Immunotherapy is a type of treatment that uses your body's own immune system to help fight cancer. It can be given alone or in combination with chemotherapy or other immunotherapy medications. This usually depends on whether the cancer is in its early stages or advanced stages (metastatic). 

Some types of immunotherapy for lung cancer also work better for certain people. This is because immunotherapy treatments for NSCLC are generally based on PD-L1 status. The more PD-L1 you have, the more likely these medications can work. But immunotherapy can still be effective for people who have low PD-L1, especially if it’s used along with chemotherapy.

In NSCLC treatment, immunotherapy medications called immune checkpoint inhibitors are most often used. These include medications like:

• Nivolumab (Opdivo)

• Pembrolizumab (Keytruda)

• Atezolizumab (Tecentriq)

• Ipilimumab (Yervoy)

• Cemiplimab (Libtayo)

• Durvalumab (Imfinzi)

Keep in mind that not all lung cancers should be treated with immunotherapy. In most cases, immunotherapy shouldn’t be a first-choice treatment if the lung cancer cells have a driver mutation present. In this case, a first-choice treatment could be a targeted therapy medication.

Targeted therapy medications for non-small cell lung cancer

Targeted therapy medications for NSCLC work by stopping the effects of driver mutations and other factors that encourage cancer growth. Many of them are available. And they can target one or more mutations.

As mentioned, your cancer specialist can test your cancer to see if it has one or more mutations. For instance, if test results come back and show that your cancer has an EGFR mutation, you may be eligible to receive a medication like Tagrisso.

Is one non-small cell lung cancer medication better than the rest?

No. There isn’t one best medication for treating NSCLC. Treating NSCLC isn’t a one-size-fits-all approach. 

The best treatment depends on your situation. Depending on the severity and type of NSCLC, one or more medications may be used. Chemotherapy is often involved. And in general, if a tumor has a driver mutation or expresses PD-L1, targeted therapy or immunotherapy may also be used. 

It’s also important to keep in mind that chemotherapy, immunotherapy, and targeted therapy can cause side effects. Some of these are unpleasant or become serious. These can also affect what medication works best for you. 

For example, chemotherapy is known to cause side effects. But for many people, targeted therapy side effects and immunotherapy side effects can be bothersome, too.

If you experience any troubling side effects from your medication, make sure to talk to your cancer specialist. They may be able to adjust your treatment plan to account for any side effects. 

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Written by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

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