Systemic Anti Cancer Therapy (SACT)

The information in this website is a summary of how lung cancer is diagnosed and treated in Scotland. You can access additional information about lung cancer from Macmillan and Cancer Research UK (CRUK) and from the resources page of this website. 

Types of lung cancer 

There are two main types of lung cancer, these can be identified from a sample taken from your tumour. 

Approximately 80% people will have non-small cell lung cancer. This includes squamous cell cancer and non-squamous cell cancer. 

Knowing the specific type will help guide choice of most effective drug treatment. 

For early-stage non-small cell lung cancer, surgery or high dose radiation will be a possible treatment option, but medicines may be added in as part of the treatment plan. 

For advanced stage cancer, where the cancer has spread beyond the chest, then medicines will often be the main part of the treatment. 

20% patients have Small Cell Lung Cancer (SCLC). 

A minority of patients with small cell cancer will have ‘limited’ stage disease which means the tumour has not spread beyond the chest.   

Most patients at the time of diagnosis have ‘extensive’ disease which means the cancer has spread beyond the chest. Information on limited or extensive disease can be found here. 

For all patients with small cell lung cancer, chemotherapy is usually the first-choice treatment. This may depend on how fit you are, as the risks from intensive treatment may outweigh the benefits in advanced disease. 

Drug Treatment

Medicines for cancer are sometimes called Systemic Anti-Cancer Therapy or SACT.  There are three categories of anti-cancer medicines used for lung cancer: Chemotherapy, Targeted therapy and Immunotherapy. 

You can read more about chemotherapy for lung cancer on the Cancer Research UK site. Macmillan Cancer Support has helpful information on the drugs used and what to expect. 
 
Non-small cell lung Cancer Chemotherapy  
– Usually includes Cisplatin or Carboplatin – Likely in combination with one other type of chemotherapy drug 
such as Pemetrexed , Gemcitabine,Vinorelbine or Paclitaxel 

Small Cell Lung Cancer Chemotherapy 
– Usually Cisplatin or Carboplatin with or without Etoposide    
– May be a combination of 3 drugs given together CAV 
 If you have non-small cell lung cancer, a test is carried out on the sample of your cancer cells for genetic changes (mutations) caused by cancer. If we find mutations, we may offer you targeted therapy.  The list of mutations and targeted treatments is growing all the time.  
 
Macmillan Cancer Support has helpful information about the different types of targeted therapy for lung cancer. 
 
If your cancer cells test positive for genetic changes (mutations) there may be new drug treatments available. These may work especially well for your cancer. 
 
Your team will discuss with you which drugs or combination they think may be most helpful for you. They will provide information on the timing of these and the possible side effects. 
Your team will test the sample of your cancer for proteins (receptors) which are part of the immune system. If a high level of proteins are present, immunotherapy can be considered instead of or as well as chemotherapy. 

Immunotherapy is not suitable for everyone, and your team will discuss this with you.  They will consider your other medical conditions and the risk of harm from side effects.   
 
The specific immunotherapy drug and how it’s given depends on the type of cancer. It can also depend on the stage of disease, if other treatments (radiotherapy, surgery) are being planned.  Immunotherapy can be given: 
– alone with no other drugs 
– at the same time as chemotherapy 
– instead of chemotherapy 
– after chemotherapy 
 
You can read more about immunotherapy for lung cancer from Macmillan Cancer Support. 

What treatment is right for me? 

Before starting any medicines for lung cancer, the team looking after you will discuss the options to help decide on the best treatment for you. This includes considering what treatment best fits in with your lifestyle and priorities.  

If you have drug treatment the team will take a blood sample to check how well your kidneys and liver are working and how your blood count is doing. They will also check if you have other medical conditions and what other medicines you take. 

All cancer medicines cause unwanted (side) effects, these are different for each treatment. It is important that the benefits of drug treatment outweigh the possible negative effects if you are having treatment. The team looking after you will give you information about this risk of side effects.  They will also give you advice and medicines to help prevent/treat side effects as much as possible.  

  

The team looking after you will be able to explain what to expect when you come for treatment. Some questions you might like to ask:  

  • Can I bring someone to stay with me while I have treatment?  
  • Will I be able to drive/take public transport after my treatment?  
  • How long will my treatment take?  
  • Do I need to have any blood tests before treatment?  
  • Who will review me before each treatment?    
  • Will they phone me, or do I have to come in to see somebody?  

  

To find out more about preparing for cancer treatment:  

Cancer Research UK 

Macmillan Cancer Support 

  

When are drugs used within my treatment schedule?  

Drug treatment given before surgery or radiotherapy  
Drug treatment given after surgery or radiotherapy  
Drug treatment given at the same time as radiotherapy 

Medicines can be given in different ways:  

A tablet or capsule given by mouth 
An injection given under the skin  
Through a tube into a vein