Non-Small Cell Lung Cancer - Radiation Treatments

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• Diarrhea
• Temporary hair loss
• Weight loss
• Fatigue
• Depression
• Nausea and vomiting: Drugs known as serotonin antagonists, especially ondansetron (Zofran), can relieve these two side effects. Serotonin antagonists work well in nearly all patients given moderate chemotherapy drugs, and in most patients who take more powerful drugs.
• Anemia: An abnormally low number of red blood cells is common in lung cancer. One treatment involves transfusions or injections of erythropoietin, a drug that increases red blood cell production. Erythropoietin is available as epoetin alfa (Epogen, Procrit) and darbepoetin alfa (Aranesp), which requires fewer injections. These drugs are recommended when a patient's hemoglobin level falls below a certain level, usually less than 10 g/dL.

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These side effects are nearly always temporary. Most patients are able to continue with their normal activities for all but perhaps 1 or 2 days per month.

Serious complications of chemotherapy can also occur, and vary depending on the specific drugs. These complications include:

• Increased chance for infection from suppression of the immune system.
• Severe drop in white blood cells (neutropenia): Certain chemotherapy drugs, such as taxanes, pose a higher risk for this complication than other drugs. A drug called granulocyte colony-stimulating factor (filgrastim and lenograstim) can improve the white blood cell count.
• Liver and kidney damage: Amifostine (Ethyol) reduces the risk for kidney damage in patients taking repeated regimens of cisplatin-based therapy. It is also a radioprotector; that is, it helps prevent severe effects in the esophagus from radiotherapy, with or without chemotherapy.
• Abnormal blood clotting (thrombocytopenia).
• Allergic reaction, particularly to platinum-based agents: A simple skin test is under investigation that may identify people with a potential allergic response.

Second-Line Chemotherapy

Second-line chemotherapy is used for patients whose cancers have come back after the first round of chemotherapy. Several of these agents listed below have prolonged survival for patients with non-small cell lung cancer. Unfortunately, this survival benefit is usually only a matter of several months. Efforts are under way to identify which patients are more likely to benefit from these therapies. Because platinum-based agents are most often used first, they are not beneficial for second-line therapy.

Commonly used second-line agents include: