How Targeted Therapy for Lung Cancer Works

What Is Targeted Therapy?

Targeted therapy is a type of drug therapy that acts specifically against cancer cells or the biological processes that support their development and growth. This approach differs from standard chemotherapy, which can affect both healthy and cancerous cells. Targeted therapy mostly leaves healthy cells alone. Targeted therapy has achieved promising results in treating many types of solid tumors, including in breast cancer, colorectal cancer, skin cancer, and lung cancer, as well as in managing several cancers of the blood and blood-forming tissues. While targeted therapy is an important treatment option, it most often is used in conjunction with – rather than instead of — other treatment methods, such as chemotherapy, surgery, radiation, and immunotherapy.

How Does Targeted Therapy Work?

Cancer cells have genetic mutations that make them different from normal cells. Targeted therapy medicines aim at these mutated cells, preventing the cancer from growing and spreading. Because many genes can contribute to the development of a certain type of cancer, such as lung cancer, not every patient with that disease will have a genetic mutation that can be targeted by currently available therapies. As a result, while one person with lung cancer may be a good candidate for targeted therapy, another person with lung cancer may not. However, scientists are working to identify the various genetic mutations that contribute to the development of different kinds of cancer and are striving to formulate therapies that will be effective against cancer cells with those mutations. Other forms of targeted therapy, meanwhile, work to interfere with or prevent processes that contribute to the growth of a cancer, such as by blocking the production or syntheses of androgens, the male sex hormones that can fuel the growth of prostate cancer.

When determining the best treatment approach for a patient with cancer, physicians will consider whether genetic testing of the tumor or the patient’s blood is warranted to identify genetic mutations that may make that patient a good candidate for a targeted therapy.  Different targeted drugs have varying mechanisms of action, including: 

• Blocking chemical signals that tell cancer cells to grow and divide
• Changing proteins within cancer cells so the cells die
• Stopping the formation of new blood vessels that provide oxygen and nutrients to cancer cells
• Triggering the immune system to kill cancer cells
• Carrying toxins to cancer cells to kill them while leaving normal cells unharmed

Types of Targeted Therapy Drugs

There are many types of targeted drugs, and they work in different ways. That means the treatment process and side effects for each can vary. Targeted therapy drugs can be either small-molecule drugs or large-molecule drugs. Small-molecule drugs are small enough to enter cancer cells and acts against a specific substance or biological process inside the cell. Large-molecule drugs are generally too big to fit into cells, but they can still attack targets on the surfaces of the cells. Types of targeted drugs include:

• Monoclonal antibodies:These drugs are made of large molecules that block or interfere with specific targets outside cancer cells so the cancerous cells will die.
• Angiogenesis inhibitors:These drugs block formation of new blood vessels that feed and nourish the cancer cells.
• Proteasome inhibitors:These drugs disrupt normal cell functions and cause the cancer cells to die.
• Signal transduction inhibitors:These drugs disrupt cell signals to change the actions of cancer cells.

Lung Cancer Basics

Excluding skin cancers, lung cancer is the second most common type of cancer affecting both men and women in the United States. It also is responsible for more deaths than any other type of cancer. The disease begins when abnormal lung cells grow out of control and form a cancerous tumor. Around 87% of lung cancer cases are attributed to smoking tobacco, but people who have never smoked can still get lung cancer. There are two main types of lung cancer:

• Non-small cell lung cancer(NSCLC): This is the most common type of lung cancer in American adults, accounting for about 85% of all cases.
• Small cell lung cancer(SCLC): This is the second most common type of lung cancer and tends to grow fast but generally responds well to chemotherapy.

While a given patient’s treatment options for lung cancer will depend on the stage and type of cancer, the person’s overall health, and other factors, the treatment plan often will include both long-established treatments such as radiation and chemotherapy and cutting-edge treatments such as targeted and immunotherapy.

Targeted Therapy for Lung Cancer

Targeted therapy is often used for treating advanced lung cancers, particularly advanced non-small cell lung cancer (NSCLC). Around 30% of lung cancer patients have molecular targets that may respond to targeted therapy. Targeted therapy drugs can act against mutations including:

• Epidermal growth factor receptor (EGFR) mutations: This protein found on the surface of cancer cells helps them grow and is present in approximately 10% to 15% of people with lung cancer.
• Anaplastic lymphoma kinase (ALK) fusion: This mutation, found in about 5% of people with NSCLC, causes genes to fuse with other genes, leading to lung cancer.
• NTRK fusion:This mutation is rare for lung cancer patients, occurring in less than 1% of all cases, but causes gene fusion, leading to uncontrolled growth of cancer cells.
• BRAF V600E:This mutation in a specific variation of the BRAF protein causes cancer cells to grow and spread.
• MET exon 14 skipping:This mutation, found in more than 3% of people diagnosed with NSCLC, disrupts the protein-breakdown process, causing the propagation of growth signals that promote cancer. 
• RET fusion: This mutation is found in up to 2% of all NSCLC cases.
• ROS1 genetic changes:This rare mutation causes gene fusion and leads to uncontrolled cancer cell growth.

Targeted therapy treatment is sometimes referred to as precision medicine, as it is personalized to each patient based on information about that person’s genes, cell proteins, and mutations.

Targeted Therapy Side Effects

Targeted therapy often has fewer side effects than treatments such as chemotherapy and radiation. However, every patient responds differently to treatment, and some patients may have few or no side effects while others have more. The incidence and severity of side effects will also depend in part on the type of drug administered and its dosage. Possible side effects of targeted therapy treatment include:

• High blood pressure
• Flu-like symptoms, such as fever and chills
• Liver problems, like hepatitis and elevated liver enzymes
• Skin problems, like rashes, dry skin, and nail changes
• Swelling
• Slow blood clotting or wound healing
• Diarrhea
• Nausea
• Constipation

Generally, these side effects will go away on their own or with simple treatment, but some can be long-lasting or even permanent. Patients should contact their healthcare team about any side effects concerns.

Frequently Asked Questions About Chemotherapy

Is targeted therapy suitable for all types of lung cancer?

Currently, targeted therapy is suitable only for non-small cell lung cancer. However, scientists are evaluating the effectiveness and safety of many targeted therapies as treatments for SCLC.   

Which patients with lung cancer are eligible for targeted therapy?

Patients with non-small cell lung cancer with specific gene mutations may be eligible for targeted therapy treatment. Specialists often recommend targeted therapy when they cannot remove a tumor with surgery or when the disease has progressed despite treatment with other therapies.

How do you know if targeted therapy is working?

Patients receiving targeted therapy will have regular follow-up testing with their medical team, including physical exams, blood tests, and imaging scans, to see how the cancer is responding to the treatment.

Does targeted therapy always work?

As with any cancer therapy, there can be cases in which there is not a sufficient initial response to treatment. In other cases, a targeted therapy works well initially but cancer cells then become resistant to the targeted therapy drug, causing the medication to lose its effectiveness. However, research has shown that targeting different components of cancer cells with different drugs can work better than using just one therapy.

How are targeted therapy drugs given?

Targeted therapy drugs often come in pill form, taken orally on a daily or weekly schedule. For patients with non-small cell lung cancer, targeted therapy drugs usually come as a tablet, which is taken by mouth every day at the same time. Other targeted therapy drugs are administered intravenously.

Targeted Therapy Treatment at RCCA

Patients with lung cancer deserve to receive high-quality, comprehensive, and compassionate care without having to travel long distances. Regional Cancer Care Associates (RCCA) is dedicated to providing world-class cancer care close to home, with more than 20 community-based locations throughout New Jersey, Connecticut, Maryland, and the Washington, D.C., area. The team of 90+ cancer and blood disorder specialists provides personalized treatment plans for all patients, including those with lung cancer. Additional benefits that patients receive at RCCA include:

• Access to innovative treatment options and lung cancer clinical trials
• Patient and caregiver education and patient advocacy services
• Cancer care support, including side effects management and active surveillance

These are just some of the reasons why patients with lung cancer and other cancers come to Regional Cancer Care Associates for their cancer treatment. For more information, read through RCCA’s frequently asked questions.

Request an Appointment Today with an Oncology Specialist

Patients with lung cancer who are looking for comprehensive cancer care and innovative treatment options like targeted therapy can trust Regional Cancer Care Associates. RCCA oncologists, nurses, pharmacists, and other healthcare professionals work together to provide customized treatment plans for patients in New Jersey, Connecticut, Maryland, and the Washington, D.C., area. To learn more about targeted therapy for lung cancer at RCCA, request an appointment today.