By Carl Gay, MD, PhD, told to Hallie Levine
When patients hear the term “inoperable lung cancer,” they often think it means their cancer is incurable. But thanks to advances in treatment in recent years, this diagnosis does not mean a death sentence. There are many treatments available to slow its spread, and sometimes even put you into full remission.
There are several reasons why a patient may have inoperable lung cancer:
- Your cancer has spread. If you have stage III or IV lung cancer, it may have spread (metastasized) beyond your lungs to the chest wall, heart, and even other organs further away.
- You have small cell lung cancer (SCLC). It is a rarer form of lung cancer and accounts for about 14% of all cases. Usually, SCLC has spread by the time doctors find it.
- It is difficult to remove the cancer. If the tumor is near a blood vessel or other organ, your doctor may not want to take the risk.
- You have another high-risk health condition. If you already have a lung condition such as chronic obstructive pulmonary disease (COPD) or are in very poor health, your doctor may be concerned that you are not strong enough to withstand surgery.
Whatever the reason your lung cancer is inoperable, there are safe and effective treatments. Here’s how to make sure you’re getting the most out of your therapy.
Be Aware of Game-Changing Therapies
Historically, we have always treated patients with inoperable lung cancer with chemotherapy and radiotherapy at the same time. This usually shrinks the cancer, although it may not be enough to allow a patient to go into complete remission. But over the past decade, we’ve developed several revolutionary new tools to use in our arsenal. The main one is the use of immunotherapy, drugs that help a person’s immune system recognize and destroy cancer cells more effectively. Here are some examples :
Durvalumab (Imfinzi). This is a drug that binds to a certain protein, PD-L1, and helps your immune system kill cancer cells. It is used alone or with other medicines to treat adults with inoperable small cell and non-small cell lung cancer. A 2022 study found that the 5-year survival rate of patients with non-small cell lung cancer who received durvalumab and chemotherapy was 42.9%, compared to just 33.4% of those who received chemotherapy alone.
Osimertinib (Tagrisso). Another promising option is using a type of medication known as a tyrosine kinase inhibitor (TKI) after chemotherapy and radiation therapy. This seems to have the best results in patients with a certain type of lung cancer called EGFR-positive cancer. EGFR is a protein on cells that helps them grow. If you have an EGFR gene mutation, your cells can go haywire and grow too large, causing cancer. It appears to offer significant benefit to patients with late-stage EGFR-positive cancers, but research is ongoing to determine whether it also has benefit for early-stage, non-operative cancers.
If you’re told you have inoperable lung cancer, your doctor is your best source for treatment advice. You can also ask your doctor about a clinical trial, which is a type of study that tests new lung cancer treatments before they are available to everyone. Your doctor can tell you if there is one that might be right for you.
Manage side effects
The side effects of treatment for inoperable lung cancer are quite unique due to the double whammy of chemo and radiation therapy. Early-stage lung cancer usually involves surgery, followed by a short round of radiation that can cause minor side effects such as skin irritation. But inoperable lung cancer requires a higher dose, for longer periods. This can cause side effects such as irritation of the lungs – which
brings shortness of breath and/or a cough – and even irritation of the esophagus, which can make swallowing quite painful. Chemotherapy can cause side effects such as fatigue, anemia, hair loss and, more seriously, a higher risk of serious infection due to a decrease in blood counts.
Considering all these nasty side effects, one would expect patients to have trouble adhering to their treatment. Surprisingly, they are not. I think one of the reasons is that patients fall into an almost natural routine – radiotherapy every day from Monday to Friday and chemotherapy every week. They don’t have time to think about it too much. But I always stress to my patients that you don’t have to be a hero. Many of our patients can be stoic. Their instinct is to go with the flow and not raise issues.
If you are undergoing chemotherapy and radiation therapy for your inoperable lung cancer, it is very important to communicate regularly with your doctor. Inform them of any side effects at the first sign. If you start to feel pain when swallowing, for example, don’t wait until you can barely eat or drink before telling your doctor. There are medications we can prescribe to relieve some of these symptoms to make the whole process easier. This will then make it easier for you to stick to your entire treatment plan.
Realize that there is hope for all patients
Inoperable cancer is not always metastatic cancer. But sometimes it can be. In these cases, what I always emphasize to my patients is the increasing personalization of therapy. We can now perform a genetic analysis of a person’s tumor and treat it based on its likelihood of responding to a particular targeted therapy.
Patients are often baffled by the numbers, and for good reason: the current 5-year survival rate for metastatic lung cancer, for example, is only around 8%. But I remind my patients that these numbers are based on people who were diagnosed at least 5 years ago. If you are diagnosed with inoperable metastatic lung cancer today, you may have a better outlook with improved treatments.