In the clinical treatment of lung cancer, chemotherapy is one of the core means to fight against tumors, and plays an irreplaceable role in inhibiting tumor progression and prolonging patient survival.
However, the side effects associated with chemotherapy have made many patients and their families turn pale at the mention of "chemotherapy". This fear often stems from a lack of understanding of chemotherapy.
Regarding the chemotherapy-related issues that lung cancer patients are concerned about, we have invited Professor Yang Nong, a specially-appointed expert from Hainan Cancer Hospital, to answer questions and dispel doubts.
Does every lung cancer patient need chemotherapy?
Answer
Professor Yang Nong: Not all lung cancer patients need chemotherapy. Clinically, there are three types of lung cancer patients who have the opportunity to be exempted from chemotherapy, as follows:
The first category is patients with early-stage non-small cell lung cancer:
Taking patients in stage 1A and 1B as an example, current clinical guidelines have clearly confirmed that these patients have a very low risk of recurrence and can achieve clinical cure through standardized surgical resection, therefore chemotherapy is not necessary.
The second category is patients with advanced lung cancer who have clear gene mutations:
If patients are found to have common driver gene mutations such as EGFR and ALK, and do not have concomitant gene mutations with poor prognosis (such as TP53, RB1, etc.), first-line treatment may prioritize single-agent targeted therapy, which has higher precision and lighter side effects, and can effectively replace chemotherapy in exerting anti-tumor effects.
Why is chemotherapy still used despite its side effects?
Answer
Professor Yang Nong: Any drug may have adverse reactions, and the side effects of chemotherapy stem from its mechanism of action - when killing rapidly proliferating cancer cells, it may damage normal cells that grow rapidly, such as hair follicles and digestive tract mucosa, causing reactions such as hair loss and nausea.
However, the core reason why chemotherapy has been used in the field of tumor treatment for more than 80 years is its irreplaceable clinical value:
Chemotherapy is widely applicable and covers the entire course
Targeted therapy requires specific mutations, while immunotherapy requires biomarkers, both of which have screening conditions. Chemotherapy, either single drug or combination therapy, covers almost all stages of lung cancer, especially when targeted and immunotherapy are ineffective or resistant. It is a key "backup" method.
Technological advances have significantly optimized the safety of chemotherapy
New drug research and development has significantly improved the control of allergic reactions in new chemotherapy drugs, with milder side effects.
More importantly, the side effects should be mature. Most adverse reactions can be alleviated by antiemetics, and the treatment plan can be adjusted by stopping the drug, reducing the dosage, or changing the drug. From the perspective of benefits, the "advantages" of chemotherapy in controlling tumors and prolonging survival far outweigh the "disadvantages", so there is no need to panic.
Can chemotherapy drugs eliminate drug-resistant cells when targeted drugs become resistant?
Answer
Professor Yang Nong: Chemotherapy may be effective against targeted drug-resistant cells, but it is difficult to achieve 100% clearance solely through chemotherapy. Targeted drug resistance is common, as tumor cells undergo genetic mutations to form drug-resistant clones that escape drug inhibition.
The treatment should be based on "precise assessment + comprehensive intervention": first, perform biopsy and gene testing to identify the cause of drug resistance (such as new mutations, pathological transformation, etc.). If there are new targetable mutations, switch to a new generation of targeted drugs; if there is no suitable targeted treatment plan, chemotherapy can be an important option, and it can also be combined with immunotherapy and anti-angiogenic therapy; in special cases, local treatments such as radiotherapy can be combined.
Expert Introduction / Consultation Information
【 Expert Introduction 】
Yang Nong
Chief Physician, Doctoral Supervisor
Long-term employed experts of Hainan Cancer Hospital and Hainan Chengmei Hospital
He currently serves as Vice President of the Second Peoples Hospital of Hunan Province, leader of the oncology department, and head of the "Yang Nong Famous Doctor Clinic" / "Yang Nong Famous Doctor Expert Team Clinic". He is also the chief expert of the National Major Scientific and Technological Special Project, a member of the Lung Cancer Special Committee of the National Tumor Quality Control Center, the director of the Hunan Provincial Key Laboratory of Precision Diagnosis and Treatment of Lung Cancer, and the director of the Hunan Provincial Respiratory Tumor Clinical Medical Research Center. He has been dedicated to precision targeted therapy for lung cancer and gastrointestinal tumors, complex recurrent and drug-resistant clinical cases, scientific research, and teaching for nearly 30 years.
He has been honored with the title of "National Famous Doctor - Excellent Style" in the 6th session, and has been recommended by patients across the country as "Annual Good Doctor" for 8 consecutive years, as well as being awarded the title of "First Brain Doctor - Famous Doctor". He has authored national guidelines, won the third prize of Hunan Provincial Science and Technology Award, garnered over 500,000 fans across the internet, and achieved over 120 million views in anti-cancer science popularization.
Medical expertise
Specialties: Precision treatment of lung cancer, breakthrough in difficult-to-treat, recurrent, and drug-resistant cases with brain metastasis; individualized and precise treatment for brain metastases of lung cancer; early diagnosis of pulmonary nodules and lung cancer; personalized and comprehensive diagnosis and treatment for various solid tumors; clinical trials of the latest immunotherapy/targeted therapy drugs.
·With nearly 30 years of experience in precision immunotherapy for lung cancer, I have led nearly 400 phase I-III clinical trials of new anticancer drugs (including national Class 1 new drugs), and am particularly skilled in treating complex cases such as refractory, recurrent, and drug-resistant conditions, as well as brain metastases.
·Early diagnosis and treatment of pulmonary nodules and lung cancer, with over 2,000 cases diagnosed annually (over 10,000 cases accumulated from 2019 to 2024), and a detection rate of over 90% (retrospective study in 2023).
·He is also proficient in the comprehensive diagnosis and treatment of multiple cancer types, individualized, and interdisciplinary, covering a wide range of solid tumors (such as stomach/intestine/brain tumors).
· Professor Yang Nong has received over 14,000 visits annually (data from 2023).
· Managed the "Lung Cancer Immunotherapy Patient Group", providing long-term follow-up care for over 4,000 lung cancer patients who have achieved long-term survival, accumulating rich clinical experience.
[Visit information]
01 【Clinic Hours and Location】
September 27th, 14:00-17:00
The sixth consultation area of Hainan Cancer Hospital
02 [Appointment registration]
Follow the official account of Hainan Cancer Hospital for "appointment registration"
03 [Health Consultation]
13876807106
04 [Friendly Reminder]
To facilitate the expert in understanding your condition as soon as possible, please bring along:
1. ID card, medical insurance card, mobile phone
2. Accompany immediate family members (with decision-making authority)
3. Arrange the relevant examinations you have undergone in chronological order
4. Paper medical records of previous visits
5. Surgical case biopsy: wax block or 20-30 white slides
6. Pathological diagnosis report
7. Inpatient medical records and notes
8. Recent relevant examinations
9. The patients current treatment plan
10. Several most pressing questions I want to inquire about