Lung Cancer and Treatment Options: A Guide for Pharmacists

Lung cancer is one of the leading causes of death worldwide. Those that smoke are at a notably higher risk of lung cancer, although it can also occur in those that do not smoke themselves.¹ An estimated 230,000 people were diagnosed with lung cancer in the US in 2023, and approximately 1 in 16 men and 1 in 17 women will be diagnosed with lung cancer in their lifetime.²

3d illustration of lung cancer | Image credit: appledesign | stock.adobe.com

Lung cancer does not show symptoms early on and primarily only has symptoms when the disease has advanced, making early diagnosis challenging. Some of these symptoms may include a cough that does not go away, chest pain, coughing up blood, hoarseness, shortness of breath, and wheezing. When the disease spreads, patients may show other symptoms such as bone pain, headache, weight loss, loss of appetite, and swelling in the face or neck.¹

Lung cancer is mainly divided into 2 major types: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). SCLC typically occurs in those who have smoked heavily for years and is less common than NSCLC. NSCLC encompasses squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.¹

Risk factors for lung cancer may include exposure to smoke (either first- or second-hand) and previous radiation therapy (especially in the chest) for a previous diagnosis. Exposure to cancer-causing substances such as carcinogens—including asbestos, arsenic, chromium, and nickel—may increase the chances of developing lung cancer. Lastly, family history of lung cancer is known to play a role in development of the disease.¹

Diagnosis typically includes imaging tests, and sputum cytology of the mucus may also show lung cancer cells. Biopsy is another option to check the cells growing in the lungs, whereas thoracentesis can check the fluid around the lungs to see whether it is cancerous.^1,3

Treatment options for patients with lung cancer may include surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy, and palliative therapy. Surgical options may include wedge resection, segmental resection, lobectomy, and pneumonectomy.¹

Targeted therapies are able to target proteins involved in the growth and spread of cancer. These treatments are advancing quickly as researchers gain better understanding of DNA changes and proteins that drive cancer. Most targeted therapies are either small-molecule drugs or monoclonal antibodies.⁴

Targeted therapies available for lung cancer include adagrasib (Krazati; Bristol Myers Squibb), afatinib (Gilotrif; Boehringer Ingelheim), alectinib (Alecensa; Genentech), atezolizumab (Tecentriq; Genentech), bevacizumab (Avastin; Genentech), cemiplimab (Libtayo; Regeneron), durvalumab (Imfinzi; AstraZeneca), erlotinib (Tarceva; Genentech), trastuzumab (Enhertu; Daiichi-Sankyo, AstraZeneca), ipilimumab (Yervoy; Bristol Myers Squibb), and others.⁵

As patients are navigating these treatments and clinicians are deciding treatment approaches, pharmacists can play a crucial role in providing information and helping patients access services. The costs of these personalized therapies can be significant, and pharmacists can help patients find financing options or identify alternative choices and strategies to manage availability. Additionally, pharmacists have been shown to contribute to improved adherence rates, therapy optimization, patient safety, and cost-savings. Pharmacists are increasingly taking a more direct role in patient care.⁶

More patients die from lung cancer than colon, breast, and prostate cancers combined, signaling how crucial these treatments are. Optimistically, however, the number of new lung cancer cases is continuing to decrease as more people are quitting smoking and research is advancing early detection and treatment of lung cancer.⁷

REFERENCES

1. Lung cancer. Mayo Clinic. April 30, 2024. Accessed August 27, 2024. https://www.mayoclinic.org/diseases-conditions/lung-cancer/symptoms-causes/syc-20374620

2. Lung Cancer Facts 2023. Lung Cancer Research Foundation. Accessed August 27, 2024. https://www.lungcancerresearchfoundation.org/lung-cancer-facts/?gad_source=1&gclid=Cj0KCQjwt4a2BhD6ARIsALgH7Do8fP4gPxldDYEPkZJOm_9CRzdoMD-cCO-uuSVlQJjoiDXEA9KORzYaAgLaEALw_wcB

3. Lung Cancer Diagnosis. American Lung Association. Updated June 7, 2024. Accessed August 27, 2024. https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/symptoms-diagnosis/how-is-lung-cancer-diagnosed

4. Targeted Therapy to Treat Cancer. National Cancer Institute. Updated May 31, 2022. Accessed August 27, 2024. https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies

5. List of Targeted Therapy Drugs Approved for Specific Types of Cancer. National Cancer Institute. Updated August 22, 2024. Accessed August 27, 2024. https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies/approved-drug-list#targeted-therapy-approved-for-lung-cancer

6. Berumen E, Falade O, Millican L, John J, Adeoye A, Rogers S. Advancing Pharmacists’ Role in Personalized Treatment for Breast, Prostate, and Lung Cancer. Pharmacy Times. February 22, 2024. Accessed August 27, 2024. https://www.pharmacytimes.com/view/advancing-pharmacists-role-in-personalized-treatment-for-breast-prostate-and-lung-cancer

7. Key Statistics for Lung Cancer. American Cancer Society. Updated January 29, 2024. Accessed August 27, 2024. https://www.cancer.org/cancer/types/lung-cancer/about/key-statistics.html