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Is Non-Small Cell Lung Cancer Aggressive?

Non-small cell lung cancer (NSCLC) is less aggressive than small cell lung cancer. NSCLC tends to develop slowly and causes few or no symptoms until it is advanced. Life expectancy for non-small cell lung cancer depends on whether it has spread outside the lung.
Non-small cell lung cancer (NSCLC) is less aggressive than small cell lung cancer. NSCLC tends to develop slowly and causes few or no symptoms until it is advanced. Life expectancy for non-small cell lung cancer depends on whether it has spread outside the lung.

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for 80% to 85% of cases, and it is less aggressive than small cell lung cancer. NSCLC tends to develop slowly and causes few or no symptoms until it is advanced.

There are three main types of non-small cell lung cancer:

  • Adenocarcinoma of the lung
    • The most common form of lung cancer, accounting for 30% of all cases overall and about 40% of all non-small cell lung cancers
    • Diagnosed mainly in current and former smokers
  • Squamous cell cancer of the lung
    • Accounts for about 30% of all non-small cell lung cancers
    • Generally linked to smoking
  • Large-cell undifferentiated carcinoma
    • Accounts for 10 to 15 percent of cases of NSCLC 
    • Grows and spreads quickly and can be found anywhere in the lung

Life expectancy for lung cancer is often expressed in five-year survival rates, that is, how many people will be alive five years after diagnosis. 

Non-Small Cell Lung Cancer (NSCLC) Five-Year Survival Rates Chart
Lung Cancer Type Five-Year Survival Rate
Localized NSCLC (cancer that has not spread outside the lung) 61%
Regional NSCLC (cancer has spread outside the lung to nearby structures or lymph nodes) 35%
Distant NSCLC (cancer has spread to distant parts of the body, such as the brain, bones, liver, or the other lung) 6%

How Is Non-Small Cell Lung Cancer (NSCLC) Treated?

Treatment for non-small cell lung cancer (NSCLC) depends on the stage, and may include:

Treatment for stage 0 NSCLC includes:

  • Surgery 
    • Usually able to cure stage 0 NSCLC because the cancer is limited to the lining of the airways
      • Removal of the tumor 
      • Removal of the lobe of the lung that has the tumor (lobectomy) or removal of a smaller piece of the lung (sleeve resection, segmentectomy, or wedge resection) 
      • Lobectomy or sleeve resection or removal of the entire lung (pneumonectomy) 
  • Alternatives to surgery may be possible for some stage 0 NSCLC
    • Photodynamic therapy 
    • Laser therapy
    • Internal radiation (brachytherapy)

Treatment for stage I NSCLC includes:

  • Surgery
    • Lobectomy
    • Sleeve resection
    • Pneumonectomy
    • Lymph node removal
  • Adjuvant chemotherapy (“chemo”) after surgery
    • Used for patients with stage I NSCLC that has a higher risk of coming back
  • Radiation after surgery
  • Treatment for those who are unable to have surgery may include
    • Stereotactic body radiation therapy or another type of radiation therapy 
    • Radiofrequency ablation 

Treatment for stage II NSCLC includes:

  • Surgery
    • Lobectomy
    • Sleeve resection
    • Pneumonectomy
    • Lymph node removal
  • Adjuvant chemotherapy after surgery
    • People whose cancer cells have mutations in the EGFR gene may receive adjuvant treatment with the targeted drug osimertinib (Tagrisso)
  • Radiation after surgery
  • Radiation therapy may be the main treatment for patients unable to have surgery 

Treatment for stage IIIA NSCLC includes:

  • A combination of radiation therapy, chemotherapy, and/or surgery
    • Treatment often starts with chemo, which may be combined with radiation therapy (called chemoradiation)
    • Sometimes surgery is the first treatment option, and other times, it may be performed after chemo/radiation
      • People whose cancer cells have mutations in the EGFR gene may receive adjuvant treatment with the targeted drug osimertinib (Tagrisso)
    • If surgery, radiation, and chemoradiation are not viable treatment options, immunotherapy may be the first line treatment 
      • Pembrolizumab (Keytruda) 
      • Cemiplimab (Libtayo) 

Treatment for stage IIIB NSCLC includes:

  • Surgery is not usually used at this stage
  • Chemotherapy combined with radiation therapy (chemoradiation)
    • If the cancer is under control after 2 or more treatments of chemoradiation, the immunotherapy drug durvalumab (Imfinzi) can be given for up to a year to help keep the cancer stable
  • Patients not healthy enough for chemoradiation may be treated with radiation therapy alone, or, less often, chemo alone
  • If surgery, radiation, and chemoradiation are not viable treatment options, immunotherapy drugs may be the first line treatment 
    • Pembrolizumab (Keytruda) 
    • Cemiplimab (Libtayo) 

Treatment for stage IVA and IVB NSCLC includes:

  • NSCLC at these stages can be very hard to cure 
    • Treatment may relieve symptoms and help patients live longer
  • Surgery
  • Chemotherapy (chemo)
  • Targeted therapy
  • Immunotherapy
  • Radiation therapy 
  • Photodynamic therapy
  • Laser therapy
  • Medications (the choice depends on genetic mutations present)
    • Sotorasib (Lumakras) 
    • Osimertinib (Tagrisso)
    • Crizotinib (Xalkori)
    • Entrectinib (Rozlytrek)
    • Ceritinib (Zykadia)  
    • Dabrafenib (Tafinlar) 
    • Trametinib (Mekinist) 
    • Selpercatinib (Retevmo) 
    • Pralsetinib (Gavreto) 
    • Capmatinib (Tabrecta) 
    • Tepotinib (Tepmetko) 
    • Larotrectinib (Vitrakvi) 
    • Entrectinib (Rozlytrek) 
    • Pembrolizumab (Keytruda)
    • Atezolizumab (Tecentriq)
    • Cemiplimab (Libtayo) 
    • Nivolumab (Opdivo) 
    • Ipilimumab (Yervoy)
    • Necitumumab (Portrazza)

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References
https://www.cancer.org/cancer/lung-cancer.html

https://www.cancercenter.com/cancer-types/lung-cancer/types