Treatment for lung cancer has improved in recent
years, but it remains one of the most difficult to treat cancers. The type of
treatment you may receive depends on
how advanced the cancer is at diagnosis, how many tumours there are and whether
it has spread to nearby lymph nodes or other parts of the body. Most
people receive a combination of treatments, for example surgery and chemotherapy.
Surgery: If lung
cancer is caught early, it may be possible to remove all or most of it with
surgery. This is usually not possible if the cancer has spread.
Radiotherapy: Radiation
may be used to destroy cancer cells. Usually it is given with a large machine
that aims beams of radiation at the affected part of the lung. Radiation can sometimes
shrink tumours that cannot be removed, which can help relieve pain and other
symptoms.
Chemotherapy: Traditional
chemotherapy drugs stop cells from dividing. It affects both cancer
cells and fast-growing healthy cells, which can lead to side-effects. Many chemotherapy
drugs are given through a drip into a vein.
Targeted therapy: Targeted or precision medications are designed to attack
cancer with specific characteristics, for example certain gene mutations. Many
targeted therapies interfere
with signalling pathways that regulate cell growth. Over time, cancer cells
can sometimes
develop resistance to them. Some lung cancers have mutations (such as EGFR or
ALK) that have effective targeted therapies, but drugs have not yet been
discovered for other common mutations. Targeted therapies may be small
molecules taken as pills or monoclonal antibodies given through an intravenous (IV)
drip.
Immunotherapy: Immune-based
medications help the immune system identify and attack cancer cells.
Some
tumours can turn off immune responses against them, and drugs known as checkpoint
inhibitors release the brakes and restore T cell activity. Some checkpoint
inhibitors, alone or in combination with chemotherapy, have shown good results
in people with lung cancer. But they don't work for everyone and it is
difficult to predict who will benefit.
Like any other treatment, cancer medications
can have side-effects. Traditional chemotherapy destroys fast-growing healthy
cells, such as those in the hair follicles, bone marrow and gut. Targeted
medications are more specific than chemotherapy, but can still cause side-effects. Immunotherapy can
sometimes trigger excessive immune responses against healthy tissue. It’s
important to ask about the potential side-effects of the treatment you're
considering. You may be given additional medications to manage side-effects,
for example anti-nausea drugs or medications that boost blood cell counts.
The British HIV Association (BHIVA)
recommends that HIV-positive people with cancer should be treated at hospitals
with experience of treating cancer in people living with HIV. BHIVA also
recommends that all people with HIV who need cancer treatment should start HIV
treatment, if they have not done so already.
People with HIV can generally use
the same types of treatment for cancer. However, people with low CD4 counts or
other co-morbidities may have poorer treatment outcomes or more side-effects.
It may be necessary to adjust cancer or HIV treatment, taking into account the
impact of each disease on the other and the potential for drug-drug
interactions. For this reason, it's important that the doctors treating your
HIV and your cancer work together.
Some cancer medications may interact
with HIV treatments. This is more likely with protease inhibitors and
non-nucleoside reverse transcriptase inhibitors, and less likely with integrase
inhibitors, so your doctor may recommend that you switch HIV medications.
Radiotherapy, chemotherapy and some
targeted therapies can harm the bone marrow, where blood cells are produced,
leading to immune suppression. This could result in a significant drop in your
CD4 count (along with other blood cells) and you may need medications to
prevent opportunistic infections (known as prophylaxis). Your CD4 count may be
checked more often during and after cancer treatment.
Most clinical trials of newer targeted
therapies and immunotherapies have not enrolled HIV-positive people, so doctors
have less experience using these medications in people with HIV. BHIVA
recommends that people with non-small-cell lung cancer should be tested for
genetic mutations and treated with appropriate targeted therapy. Unless there's
a reason to suspect they will have harmful effects, people living with HIV
should not be denied these effective new treatments.
Cancer treatment is best managed by a multi-disciplinary
team that may include oncologists (cancer specialists) and radiologists (doctors
who interpret scans or provide radiotherapy). You may be supported by cancer nurse
specialists, therapists, dietitians, your GP and others during your treatment.
If a cure is not possible, palliative care can relieve pain and other symptoms
and help you maintain the best possible quality of life.