Immunotherapy allows the immune system to recognize and attack lung cancer cells. Unlike chemotherapy or radiation, it kills cancer cells while having fewer side effects on healthy cells. It can help some patients control their disease for years, but it does not work for everyone. Treatment is specific to the type, stage, genetic profile, and spread of the cancer, so its effectiveness is determined individually.
What Is Immunotherapy for Lung Cancer, and How Does It Work?
Many patients believe cancer cells are indestructible, but in reality, they are normal cells with mutated DNA that allows for uncontrolled proliferation. These cells can trick the immune system into ignoring them by masquerading as healthy cells.
The immune system, like the body’s police force, typically detects and eliminates threats using antibodies and T-cells. Cancer’s “false ID” allows it to avoid detection. Immunotherapy drugs, particularly checkpoint inhibitors, remove this disguise, allowing the immune system to recognize and attack lung cancer cells more effectively.
What are immune checkpoint inhibitors?
Most of the time, cancer cells bump into the immune system at locations called “checkpoints,” or PD-1 and PD-L1 receptors—much as if they were driving down the street and a policeman stopped them to make sure they’re allowed in that area of town.
When they arrive at these checkpoints, cancer cells simply show their ID badges and evade the immune system. What immune checkpoint inhibitors do is get in the way of that interaction. They help your immune system recognize that, in fact, that cancer cell is not a normal lung cell, and it needs to be eliminated.
Checkpoint inhibitors block the signal between lung cancer cells and your immune cells that’s interfering with your body’s ability to identify cancer cells as harmful. This triggers an immune response that causes the body to immediately release T-cells to attack and destroy the cancer cells.
Common checkpoint inhibitors used to treat lung cancer include:
- Pembrolizumab (Keytruda®)
- Nivolumab (Opdivo®). This checkpoint inhibitor is sometimes used in combination with another immune drug called ipilimumab (YERVOY®)
- Atezolizumab (Tecentriq®)
- Durvalumab (Imfinzi®)
What are the benefits of immunotherapy treatment for lung cancer patients?
- Trains the immune system to recognize and attack cancer cells, thereby leveraging the body’s natural defenses.
- Less toxic than traditional therapies and poses fewer risks to healthy cells than chemotherapy and radiation.
- Can be continued indefinitely; some patients have received immunotherapy for years.
- Provides long-term responses—cancer activity may disappear on scans in rare cases, but in many others, the disease is under control.
- Provides proven survival benefits, with FDA-approved medications such as pembrolizumab and nivolumab improving outcomes in advanced NSCLC.
- Contributes to lower lung cancer death rates, which are being driven in part by advances in immunotherapy.
What are the side effects of immunotherapy for lung cancer?
The majority of patients receiving an immunotherapy treatment to fight lung cancer experience few side effects. That said, some patients do experience side effects—usually mild—that are often associated with an overactive immune system. This is a possible consequence of using immunotherapy drugs to boost your body’s defenses.
The most common side effects patients experience while receiving treatment include:
- Fatigue
- Skin rash
- Diarrhea
- Overactive or underactive thyroid
- Inflammation in the lungs and/or liver
While most doctors are familiar with the side effect profiles of chemotherapy or targeted therapy drugs, many are less familiar with immunotherapy side effects, and they may be more difficult to spot than those caused by conventional treatments. When patients do experience side effects, we usually stop treatment, administer steroids, and evaluate whether they can tolerate further treatment with immune drugs.
At CTCA®, we only treat cancer, so our doctors and care team are attuned to immunotherapy toxicities and are better able to pinpoint them and quickly mitigate their effects when they happen. Patients at CTCA also have access to integrative care services that provide supportive care therapies, such as nutritional support, painmanagementet and behavioral health services, which are designed to prevent and manage side effects associated with cancer and its treatment.
Who is a candidate for immunotherapy?
Immunotherapy is used to treat patients with stage 3 or stage 4 lung cancer. Patients with advanced non-small cell lung cancer or small cell lung cancer may be eligible. The first step to determining whether you’re a good candidate may be to undergo advanced genomic testing and PD-L1 testing.
With genomic testing, a pathologist runs an analysis of the molecular aspects of the DNA of the tumor cells taken from a biopsy to find out what type of mutations or alterations they express and then looks for a match to therapies shown to be effective for those mutations. This analysis could reveal a match for a targeted therapy, but in the case of immunotherapy for lung cancer, your pathologist will look for PD-1 and PD-L1 immune markers, which detect how sensitive cancer cells may be to checkpoint inhibitors.
Results for this specific genomic test come back in the form of a percentage. If the result is above 50 percent, you may be able to be treated with immunotherapy alone. If it’s below 50 percent, you may be better suited for a combination of immunotherapy and chemotherapy.
Who isn’t a good candidate for immunotherapy?
If your genomic test shows your cancer cells have an epidermal growth factor receptor (EGFR) mutation, your lung cancer may be treated with a targeted therapy drug instead. In cases where targeted therapy doesn’t work or stops working, immunotherapy may be used as a secondary treatment option later.
Patients with autoimmune diseases, such as multiple sclerosis, Crohn’s disease, rheumatoid arthritis, and lupus, may also not be good candidates for immunotherapy.
As we explained above, immunotherapy drugs ramp up your immune system, which may be a problem for people whose immune system is already overactive, as is the case with patients suffering from autoimmune diseases.
That said, there’s ongoing research testing the use of immunotherapy drugs on cancer patients with preexisting autoimmune diseases, so if you’re such a patient, this doesn’t necessarily mean you’re not eligible to receive immunotherapy. We recommend you consult with your physician and have him or her weigh the risk.
What should I do if I’m interested in immunotherapy treatment for my lung cancer?
Immunotherapy has quickly become a standard treatment for lung cancer, which means your oncologist will be very familiar with it. Ask your doctor whether immunotherapy would be a treatment option for your particular type and stage of lung cancer.
If you haven’t already, try to get access to genomic testing to see which mutations (changes) and biomarkers your cancer cells express. That analysis will, in turn, help you and your doctor narrow down appropriate treatment options.
You may also want to consider getting a second opinion. Many patients come to CTCA for a second opinion to get a better understanding of their lung cancer. Our cancer experts have access to a wide range of diagnostic technology tools and comprehensive treatment options, such as genomic testing, targeted therapy, and clinical trials. We also offer a personalized approach to cancer care and a team of multidisciplinary experts to help you prevent or manage the side effects of the treatment or the cancer itself.
Immunotherapy has changed oncology and the treatment of lung cancer ever since its approval and initial implementation. Immunosuppressive drugs’ side effects are, in most cases, mild compared to those of other conventional treatment options and usually facilitate a better quality of life for patients.
Ongoing advances in immunotherapy, such as the use of combinations of immune drugs taken together, give us hope that one day immunotherapy will allow a majority of advanced-stage lung cancer patients to not only survive their cancer but thrive.
Also Read: Can Immunotherapy Cure Stage 4 Cancer?
