About

Combination Therapy for lung cancer treatment is one of the latest, most exciting advances in lung cancer research.

Studies of patients being treated with combination therapy show increase in the overall survival rate for lung cancer patients.

In the 1970s, researchers discovered that using a combination of drugs to treat a cancer patient increases the chance that all of the cancer cells will be eliminated. Preliminarily, clinical trials have shown that the combination of immunotherapy with other therapy, such as chemotherapy, radiotherapy, and targeted therapy, achieve greater therapeutic effects for treating small cell lung cancer (SCLC).

Some of the positive reasons doctors may choose to recommend combination therapy for certain lung cancer patients are:

  • A single treatment might not be sufficient to make the tumor shrink.
  • Sometimes adding an additional treatment may make the original treatment work better.
  • Certain treatments might be more effective at different stages of your treatment journey.

Types of Treatment

Chemotherapy drugs affect cancer cells at different points in the cell cycle. Sometimes chemotherapy is used along with immunotherapy. The benefits seen are:

  • decreased resistance
  • earlier administration of medications
  • multiple targeted attacks
  • drugs work better together
  • lower doses can be used

Cancer cells have a way of hiding from the patient’s immune system. Immunotherapy drugs work by helping the immune system recognize and attack cancer cells. Lung cancer cells are broken down by chemotherapy drugs. This action makes the immunotherapy drugs more effective at identifying these lung cancer cells as abnormal. Combination chemotherapy is effective and can:

  • work to extend life
  • reduce the risk of cancer recurrence
  • improve the results from immunotherapy.

A recent study of adults with extensive stage small-cell lung cancer showed that the immunotherapy Imfinzi, in combination with a choice of chemotherapies, etoposide plus either carboplatin or cisplatin, showed an overall survival benefit of three years.

Possible Risks of Multiple Medications for SCLC

Of course, adding more medications to a treatment plan can augment negative reactions. The risk of adding more medications can increase the side effects. It is also possible to have unwanted interactions with medications, and, it may be difficult to determine which treatment is responsible for the negative side effect.

Recent clinical trials of patients with advanced non-small cell lung cancer showed that combinations of immunotherapy with chemotherapy are a very effective first line treatment.Combining pembrolizumab with conventional chemotherapy in the first-line setting significantly prolongs median overall survival in patients with metastatic squamous non–small cell lung cancer (NSCLC). For some people with advanced NSCLC, a targeted therapy drug or an immunotherapy drug may be given along with chemotherapy.

Combining immunotherapy with targeted radiation resulted in a greater response rate than immunotherapy alone in a phase 2 clinical trial in patients with early-stage, non-small-cell lung cancer. Recent clinical trials have suggested that combining an immunotherapy with traditional chemotherapy may be even more effective than immune-targeting drugs alone, as a pre-surgery treatment.

The initial treatment for stage 3a NSCLC may include some combination of radiation therapy, chemotherapy (chemo), and/or surgery.

Adding rivoceranib (aka apatinib) to Iressa helped keep cancer at bay in previously untreated, EGFR-mutated non–small cell lung cancer (NSCLC) patients. Apatinib works as a tyrosine kinase inhibitor (TKI) that selectively inhibits VEGFR2, while Iressa works as an epidermal growth factor receptor (EGFR) inhibitor, which interrupts signaling through the EGFR in target cells.

Neoadjuvant chemotherapy with nivolumab plus platinum-doublet chemotherapy significantly improved response rates compared with chemotherapy alone in patients with resectable stage 1b to 3a non–small cell lung cancer (NSCLC)

Lung cancer experts have been impressed by long-term study results that continue to show the combination of immunotherapy and chemotherapy doubles survival compared with chemotherapy alone. The results are from a 4-year follow-up of patients with previously untreated stage 4 non-small cell lung cancer (NSCLC) taking part in the trial of immunotherapy drug pembrozlizumab (Keytruda) plus pemetrexed–platinum chemotherapy. Previous results from the study had already demonstrated that, after a median follow-up of 10.5 months, adding pembrolizumab to chemotherapy significantly improves both overall survival and progression-free survival compared with chemotherapy alone.

Clinical trials continue for both SCLC and NSCLC evaluating which combination therapies are most effective for which patients. With the promising results seen so far, it is clear that combination therapy for lung cancer treatment shows great promise for lung cancer patients.

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What to Expect

The specific treatment plan for combination therapy will depend on the individual patient’s condition, including the type and stage of lung cancer. Here are some general aspects to expect during combination therapy:

  • Treatment Schedule: Combination therapy may involve receiving different treatments on different days or in specific cycles. The treatment schedule will be determined by the healthcare team and may vary for each patient.
  • Potential Side Effects: Like any cancer treatment, combination therapy can have side effects. These can vary depending on the specific treatments used. Common side effects may include fatigue, nausea, hair loss, and changes in blood cell counts. It is important to discuss potential side effects with the healthcare team and seek appropriate support and management strategies.
  • Monitoring and Follow-up: Regular monitoring and follow-up visits will be an essential part of combination therapy. This allows healthcare professionals to assess treatment response, manage side effects, and make any necessary adjustments to the treatment plan.

Side Effects

See side effects for each related therapy:

Chemotherapy

Immunotherapy

Targeted Therapy

FDA-Approved Combination Therapy Treatment

Types
  • Tremelimumab (Imjudo)

    FDA approved tremelimumab in combination with durvalumab and platinum-based chemotherapy for adult patients with metastatic non-small cell lung cancer (NSCLC) with no sensitizing epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) genomic tumor aberrations.

    Approved for: NSCLC

    FDA Approval Date: 11/01/2022

    Used in: Combination Therapy

  • Cemiplimab-rwlc (Libtayo)

    FDA approved cemiplimab-rwlc in combination with platinum-based chemotherapy for adult patients with advanced non-small cell lung cancer (NSCLC) with no EGFR, ALK, or ROS1 aberrations.

    Approved for: NSCLC

    FDA Approval Date: 11/01/2022

    Used in: Combination Therapy

  • Pembrolizumab (Keytruda)

    FDA approved pembrolizumab for adjuvant treatment following resection and platinum-based chemotherapy for stage 1B (T2a ≥4 cm), 2, or 3A non-small cell lung cancer (NSCLC).

    Approved for: NSCLC

    FDA Approval Date: 01/01/2023

    Used in: Combination Therapy

  • Encorafenib (Braftovi)

    The FDA has approved encorafenib plus binimetinib for adult patients with metastatic non–small cell lung cancer harboring a BRAF V600E mutation.

    Approved for: NSCLC

    Biomarkers: BRAF

    FDA Approval Date: 10/11/2023

    Used in: Combination Therapy

  • Atezolizumab (Tecentriq)

    Non-small cell lung cancer that has metastasized. It is used:

    As first-line therapy in adults whose cancer has the PD-L1 protein and does not have a mutation in the EGFR gene or the ALK gene.

    In adults whose cancer has gotten worse during or after treatment with platinum chemotherapy.

    For patients whose cancer has a mutation in the EGFR gene or ALK gene, atezolizumab is used if their disease has gotten worse after treatment with FDA-approved therapy for these mutations.

    Approved for: NSCLC

    Biomarkers: PD-L1

    FDA Approval Date: 10/31/2023

    Used in: Combination Therapy, Targeted Therapy

  • Durvalumab (Imfinzi)

    Small cell lung cancer in adults. It is used with etoposide phosphate and either carboplatin or cisplatin as first-line therapy in adults with extensive-stage disease.

    Approved for: SCLC

    FDA Approval Date: 05/19/2024

    Used in: Combination Therapy

  • Dabrafenib (Tafinlar)

    Non-small cell lung cancer that has metastasized. It is used with trametinib.Dabrafenib is used only in patients whose cancer has a certain mutation in the BRAF gene.

    Approved for: NSCLC

    Biomarkers: BRAF

    FDA Approval Date: 05/19/2024

    Used in: Combination Therapy, Targeted Therapy

  • Trametinib (Mekinist)

    Non-small cell lung cancer that has metastasized. It is used with dabrafenib.
    Trametinib is used only in patients whose cancer has a certain mutation in the BRAF gene.

    Approved for: NSCLC

    Biomarkers: BRAF

    FDA Approval Date: 05/19/2024

    Used in: Combination Therapy, Targeted Therapy