Optimizing Treatment for Inoperable Lung Cancer

By Carl Gay, MD, PhD, as told to Hallie Levine

When patients hear the term “inoperable lung cancer,” they often think that that means their cancer is incurable. But thanks to advances in treatment over the last several years, this diagnosis doesn’t mean a death sentence. There are many treatments available to slow its spread, and sometimes even put you in remission entirely.

 

There are a few reasons why a patient might have inoperable lung cancer:

• Your cancer has spread. If you have stage III or stage IV lung cancer, it may have spread (metastasized) beyond your lungs to your chest wall, heart, and even other, more distant organs.
• You have small-cell lung cancer (SCLC). This is a rarer form of lung cancer and makes up about 14% of all cases. Usually, SCLC has spread by the time doctors find it.
• It’s hard to remove the cancer. If the tumor is near a blood vessel, or close to another organ, your doctor may not want to risk it.
• You have another high-risk health condition. If you already have a lung condition such as chronic obstructive pulmonary disease (COPD) or are otherwise in very poor health, your doctor may worry that you aren’t strong enough to withstand surgery.

Regardless of the reason that your lung cancer is inoperable, there are safe, effective treatments for it. Here’s how to make sure that you make the most of your therapy.

Be Aware of Game-Changer Therapies

Historically, we’ve always treated patients with inoperable lung cancer with chemotherapy and radiation at the same time. This usually shrinks the cancer, although it may not be enough to allow a patient to go into full remission. But over the last decade, we’ve developed several new revolutionary new tools to use in our arsenal. The main one is the use of immunotherapy, medicines that help a person’s own immune system recognize and destroy cancer cells more effectively. Some examples include:

Durvalumab (Imfinzi). This is a drug that binds to a certain protein, PD-L1, and helps your immune system kill cancer cells. It’s either used alone or with other drugs to treat adults with both inoperable small-cell and non-small-cell lung cancer. A 2022 study found that the 5-year survival rate for patients with non-small-cell lung cancer who received durvalumab and chemotherapy was 42.9%, compared to only 33.4% of those who got chemotherapy alone.

Osimertinib (Tagrisso). Another promising option is the use of a type of drug known as a tyrosine kinase inhibitor (TKI) after chemotherapy and radiation. This seems to have the best results among patients who have a certain type of lung cancer known as 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 much, which causes cancer. It appears to offer significant benefits for patients with late-stage EGFR-positive cancers, but research is ongoing to see if it has benefits for early-stage non-operative cancers, as well.

If you are told that you have inoperable lung cancer, your doctor is your best source for guidance on treatment. You may also want to ask your doctor about a clinical trial, which is a type of study that tests new lung cancer therapies before they’re available to everyone. Your doctor can let you know if there is one that might be a good fit for you.

Manage Side Effects

The side effects of treatment for inoperable lung cancer are pretty unique because of the double wallop of chemo and radiation. Early-stage lung cancer usually involves surgery, followed by a short course of radiation that may cause minor side effects such as skin irritation. But inoperable lung cancer requires a higher dose, for longer periods of time. This can cause side effects such as lung irritation – which usually 

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 lowered blood counts.

Given all these unpleasant side effects, you’d expect patients to have trouble sticking to their treatment. Surprisingly, they’re not. I think one reason is because patients fall into an almost natural routine – radiation every day from Monday to Friday and chemotherapy every week. They don’t have the time to think too much about it. But I always stress to my patients that there’s no need to be a hero. A lot of our patients can be on the stoic side. Their instinct is to go with the flow and not raise issues.

If you are having chemotherapy and radiation for your inoperable lung cancer, it’s very important to communicate regularly with your doctor. Let them know about any side effect at its first sign. If you start to notice pain with swallowing, for example, don’t wait until you can barely eat or drink anything before you inform your doctor. There are medications we can prescribe to ease some of these symptoms to make the whole process easier. This in turn will make it easier for you to stick to your whole treatment plan.

Realize That There Is Hope for All Patients

Inoperable cancer is not always metastatic cancer. But sometimes, it can be. In those cases, what I always stress to my patients is the increasing personalization of therapy. We can now do a genetic analysis of someone’s tumor and treat them based on how likely they are to respond to a particular targeted therapy.

Patients are often thrown by numbers, and for good reason: The current 5-year survival rate for metastatic lung cancer, for example, is only about 8%. But I remind my patients that those numbers are based on people who were diagnosed at least 5 years ago. If you get a diagnosis of metastatic inoperable lung cancer today, you may have a better outlook, thanks to improved treatments.