These targeted therapies can often identify and attack cancer cells more effectively than conventional chemotherapy can — and usually with fewer side effects. Here’s what you need to know about this promising advance in cancer medicine.
1. Targeted therapies are more precise than standard chemotherapy.
“Traditional chemotherapy is designed to kill any rapidly dividing cells, which tend to be cancer cells. But because they don’t have a specific target, they kill healthy cells as well,” explains Edward Garon, MD, director of the thoracic oncology program at Jonsson Comprehensive Cancer Center at the University of California in Los Angeles. Targeted drugs, on the other hand, take aim at the cancer cells’ faulty genetic programming, which is what makes them different from normal cells. Doctors are learning more about specific mutations in the DNA of NSCLC cells that drive the cancer. “These mutations make proteins that send signals that lead to the development and maintenance of the cancer,” says Dr. Garon. Targeted therapies take aim at these proteins directly to stop the cancer from spreading.
2. Not all metastatic NSCLC is treated the same.
Doctors once thought NSCLC was one disease. They now understand that NSCLC can be parsed into different genetic or driver mutations that dictate the tumor’s behavior. This has led to the development of more personalized cancer medicine. “While we’re not yet at the point where we have a different drug for every single patient, we do have medicines for groups of individuals who share the same mutation in their lung cancer cells,” explains Garon. The most common mutation in NSCLC that can be treated with a targeted therapy is an abnormality in the epidermal growth factor receptor (EGFR), a protein that helps cells grow and divide. In NSCLC cells with the EGFR mutation, the signal is always on, causing these cells to grow faster. Targeted therapies called EGFR inhibitors help block this signal. The EGFR mutation is more common in women and people who haven’t smoked, according to the American Lung Association (ALA). There are also therapies approved by the Food and Drug Administration (FDA) for patients who have a mutation in the ALK, BRAF, ROS1, NTRK, RET, MET, or KRAS gene. These pills can be taken orally at home. “These drugs have been quite well tolerated and tend to cause fewer and less-severe side effects than traditional chemotherapy,” says Garon.
4. But they do cause some side effects.
“As with any drug, there can be toxicities,” Garon notes. Those will depend on the type and dose of drug you take and your overall health, but the most common side effects are a skin rash and gastrointestinal problems. Other side effects can include fatigue, flu-like symptoms, sore mouth, headache, loss of appetite, tingling in the hands and feet, taste changes, and sleep problems. Your healthcare team can help you manage any side effects you experience during treatment.
5. Targeted drugs aren’t for everyone.
According to Garon, not every genetic mutation currently has an FDA-approved targeted medication. “In addition to approved therapies, however, there are other mutations in non-small-cell lung cancer for which there are drugs showing real promise in clinical trials.” As the available targets increase, so will the percentage of patients with advanced NSCLC who are candidates for this type of treatment.
6. You need to be tested to know if targeted therapy is an option for you.
The only way to know if you’re a candidate for targeted therapy is to undergo genetic testing (aka genomic testing or molecular profiling). This involves checking a sample of your cancerous tissue for gene or chromosomal changes known to occur in NSCLC; it’s often done at the same time as your initial biopsy, and the same tissue sample can even be used for both tests. While genetic testing is considered the standard of care for metastatic NSCLC, it’s worth asking your doctor not only if you are being tested, but also exactly which mutations are being tested for, Garon stresses. “You want to make sure you’re being tested for mutations that have FDA-approved therapies, but also for mutations that may not have approved therapies yet but do have drugs showing promise in clinical trials,” he says. Comprehensive genetic testing will help you and your doctor determine all your possible treatment options.
7. Targeted drugs can be expensive.
The cost of targeted therapy depends on the drug, but newer treatments tend to be more expensive than drugs that have been used for many years, according to “The Costs of Cancer” 2020 report from the American Cancer Society’s Cancer Action Network. Health insurance typically covers at least some of the cost, but each plan is different. Yours may cover targeted drugs taken by mouth under your prescription drug benefit, rather than your chemotherapy benefit, which may mean paying more out of pocket than you would for intravenous drugs given in a hospital or clinic. Before you start treatment, find out how much your insurer will pay for any targeted drug you take. If you need help covering the cost, ask your healthcare team about getting help from the drug company or applying for a copay or prescription drug assistance program.
8. You may still need other treatments.
Patients with EGFR or ALK mutations generally get targeted therapy as a first-line treatment. “Patients with other types of mutations sometimes go with chemotherapy-based approaches initially, then move to a targeted therapy,” says Garon. Even if you start treatment with a targeted therapy alone, you may need to add other types of treatment at some point in your cancer journey. “Over time, the lung cancer cells may develop a way of continuing to grow, despite the drug, and the therapy is no longer effective,” Garon explains. How long that takes to happen can vary significantly, from several months to several years. When a targeted treatment is no longer effective, you may need to go on chemotherapy, immunotherapy, or a combination of the two.
