Immunotherapy, either alone or in combination with traditional treatments, offers significant advancements in lung cancer care. As the prevalent global cancer, lung cancer affects around 2.1 million individuals, resulting in approximately 1.7 million annual deaths, ranking as the primary cause of cancer-related fatalities for both genders.
In 2023, the United States reported 240,000 new cases and 130,000 deaths from lung cancer alone, surpassing the combined toll of breast, prostate, and colon cancers.
The integration of immunotherapy presents a noteworthy stride in improving outcomes for those grappling with lung cancer, addressing a pressing healthcare concern on a widespread scale.
Lung-Cancer Key Facts
- Lung cancer stands as the primary contributor to cancer-related fatalities on a global scale, claiming the highest number of lives among both men and women.
- Approximately 85% of all lung cancer cases are attributed to smoking, solidifying its status as the predominant cause of this deadly disease.
- Lung cancer often receives diagnoses in advanced stages, limiting available treatment options and posing significant challenges to effective intervention.
- Implementing screening measures for individuals at high risk holds the promise of early detection, offering a substantial boost to survival rates.
- Employing primary prevention strategies, such as tobacco control initiatives and minimizing exposure to environmental risk factors, emerges as a pivotal approach to reducing the incidence of lung cancer and saving lives.
What Is Immunotherapy?
Immunotherapy is a cancer treatment that boosts the body’s immune system using substances from the body or a lab. It helps find and destroy cancer cells. This treatment can be used for many types of cancer, either alone or with chemotherapy and other treatments. Immunotherapy is a promising way to fight cancer by making our immune system stronger.
What is Immunotherapy for Lung Cancer?
The immune system operates through a collaboration of diverse cells that identify foreign threats by interacting with specific proteins on their surfaces. This recognition enables the immune cells to distinguish between harmful and harmless substances.
However, certain cancer cells can evade detection by displaying proteins that make them appear safe.
Immunotherapy intervenes in this process by aiding the immune system in recognizing cancer cells, even when they attempt to disguise themselves. Approved immunotherapy drugs, sanctioned by the U.S. Food and Drug Administration (FDA), often target the disruption of interactions between proteins like PD-L1 on cancer cells and PD-1 on immune T-cells, or CTLA-4 on immune T-cells. Breaking these connections enhances T-cells’ ability to identify and respond to cancer cells effectively.
Types of Lung Cancer
There are two main types of lung cancer along with other less common:
Non-Small Cell Lung Cancer (NSCLC)
Non-small cell lung cancer (NSCLC) is the more prevalent form, constituting approximately 80 percent of all lung cancer cases. Unlike small cell lung cancer, NSCLC typically exhibits a slower growth rate and tends to spread more gradually throughout the body. This type of cancer encompasses three main subtypes:
Adenocarcinoma: Often situated in the outer regions of the lung, it originates in epithelial tissue cells, which line body cavities and surfaces, including gland formation.
Squamous Cell Carcinoma: Predominantly found near the bronchus, the air tube in the center of the lung characterizes this NSCLC subtype.
Large Cell Carcinoma: This NSCLC variant can manifest in any lung area and tends to exhibit a more rapid growth and spread compared to adenocarcinoma or squamous cell carcinoma.
While these are the most common subtypes, a closer examination of the lung cancer tumor under a microscope may unveil more specific details. Collaborate with your doctor to comprehend the precise type of lung cancer you have and its implications for treatment options.
Small Cell Lung Cancer (SCLC)
About 10% to 15% of lung cancers fall into this category, sometimes called oat cell cancer. SCLC tends to grow and spread faster than NSCLC. When diagnosed, it often has already spread beyond the lungs. While it responds well to chemotherapy and radiation therapy initially, unfortunately, it often comes back for most people.
Carcinoid
Lung carcinoid tumors, though infrequent, exhibit a slower growth rate compared to other lung cancer types. Comprising specialized neuroendocrine cells, these tumors are typically categorized as typical or atypical carcinoids. Carcinoids are exceptionally rare, characterized by a gradual progression, and are commonly addressed through surgical intervention.
Much like individuals, each type of lung cancer possesses distinct characteristics. Understanding the specific lung cancer type, often referred to as “your lung cancer profile,” is crucial as it guides the selection of available treatment options.
Pancoast
Pancoast tumors, alternatively called superior sulcus tumors, develop in the upper section of the lung and impact surrounding structures. These tumors, mostly associated with non-small cell lung cancer, are uncommon. However, they can also stem from other conditions such as lymphoma or tuberculosis. Treatment for Pancoast tumors typically involves a combination of chemotherapy, radiation, and/or surgery.
Immunotherapy and Targeted Therapy For NSCLC
Immunotherapy and targeted therapy are treatments for non-small cell lung cancer (NSCLC) that has spread beyond the lungs. They aren’t commonly used for small-cell lung cancer (SCLC), though a mix of immunotherapy and chemotherapy might be considered in some cases.
Immunotherapy drugs leverage your body’s immune system to identify and attack cancer cells. Some of these include:
Pembrolizumab
- This might be your first treatment if tests suggest.
- You might receive it alone or combined with chemotherapy.
Atezolizumab
- Given on its own after chemotherapy or in combination with a targeted therapy drug (bevacizumab) and chemotherapy.
- Used as the initial treatment for certain types of NSCLC or after previous treatment with EGFR or ALK targeted therapy drugs.
- Sometimes used with chemotherapy for extensive stage small-cell lung cancer.
Durvalumab
- Administered for up to a year after chemoradiation to lower the risk of cancer recurrence.
These drugs target a protein (PD-1) on immune system T cells and another protein (PD-L1). By blocking PD-1 or PD-L1, these drugs help the immune system identify and attack cancer cells.
Some drugs may require tests on cancer cells to check PD-L1 levels. While high PD-L1 levels may suggest effectiveness, these drugs can still be beneficial even if PD-L1 levels are not elevated.
Your doctor will guide you through the best options based on your specific situation, ensuring you receive the most suitable and effective treatment.
Types of Lung Cancer Immunotherapy
Explore diverse lung cancer immunotherapies, enhancing the body’s defenses to target and combat cancer cells effectively.
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Immune Checkpoint Inhibitors
Checkpoint inhibitors represent a type of immunotherapy, offering a novel approach to treating cancers like melanoma and lung cancer. These inhibitors work by blocking specific checkpoint proteins, crucial in regulating the immune system’s response against cancer cells.
What Are Checkpoint Inhibitors?
Checkpoint inhibitors, considered a form of immunotherapy, act as a blockade against proteins that normally prevent the immune system from attacking cancer cells. They are classified as monoclonal antibodies or targeted treatments due to their unique mechanism.
How Do They Work?
The immune system relies on T cells to defend against diseases. T cells possess checkpoint proteins that either activate or deactivate immune responses. Cancer cells, however, exploit certain proteins to turn off T cells, preventing them from attacking cancerous growths. Checkpoint inhibitors intervene by preventing these proteins on cancer cells from inhibiting T cells, reactivating the immune system to recognize and combat cancer cells.
Types of Checkpoint Inhibitors
CTLA-4 Inhibitors:
- Examples include Ipilimumab.
- Used for advanced melanoma and advanced renal cell cancer.
PD-1 Inhibitors:
- Examples include Pembrolizumab.
- Effective in treating melanoma, Hodgkin lymphoma, and non-small cell lung cancer.
PD-L1 Inhibitors:
- Examples include Atezolizumab, Avelumab, and Durvalumab.
- Atezolizumab treats lung cancer, liver cancers, breast cancers, and urothelial cancer.
- Avelumab is used for Merkel cell carcinoma and some urothelial cancers.
- Durvalumab is employed in non-small cell lung cancer.
Checkpoint inhibitors provide a targeted approach to cancer treatment by unlocking the immune system’s potential to combat cancer cells. Understanding the different types of inhibitors and their applications contributes to advancing personalized and effective cancer therapies.
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Cancer Vaccines
While vaccines are commonly associated with preventive measures against diseases, therapeutic vaccines present a unique approach to treating existing cancers. Unlike traditional vaccines, therapeutic vaccines aim to enhance the immune system’s ability to combat cancer cells. These vaccines focus on targeting proteins present in cancer cells, either exclusive to these cells or only minimally found in normal cells. In some instances, therapeutic vaccines are personalized to target proteins specific to an individual’s cancer, while in other cases, they may target cancer-specific proteins shared among a broader population.
Prior to administering the vaccine, it is often necessary to use medication that suppresses immune cells conducive to cancer growth and promotes the proliferation of immune cells capable of responding to cancer. Currently, therapeutic cancer vaccines are undergoing evaluation in clinical trials, and as of now, there is no FDA-approved vaccine specifically for the treatment of lung cancer. The research in this field represents an innovative approach to leveraging the immune system’s potential for targeting and eliminating cancer cells in individuals.
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Adoptive T Cell Therapy
Adoptive T cell therapy involves a process wherein T cells, a subset of white blood cells integral to the immune system, are extracted from the patient’s body. These T cells undergo laboratory modifications to enhance their proficiency in targeting the specific cancer cells affecting the individual. Following this alteration, the augmented T cells are reintroduced into the patient’s body to bolster the immune system’s capacity to combat the cancer.
The extraction of T cells can be carried out through plasmapheresis, a procedure that selectively filters the blood to isolate specific blood cell types. Alternatively, T cells can be obtained by extracting a portion of the tumor and separating the T cells from the surrounding tissue. As of now, this therapeutic approach is under investigation in clinical trials, and there is currently no FDA-approved adoptive T cell therapy for the treatment of lung cancer. Research in this area represents a promising avenue for developing innovative strategies to harness the patient’s immune system in the fight against cancer.
DENVAX: Dendritic Cell Therapy For Cancer
DENVAX, a breakthrough in cancer therapy, harnesses the potential of dendritic cells – the superheroes of our immune system. This personalized treatment is both non-toxic and seamlessly integrates with existing treatment plans, ensuring minimal disruption to daily routines.
Designed to combat a range of solid tumors, from lymphoma to multiple myeloma, DENVAX operates within the realm of cancer immunotherapy – the fourth pillar alongside surgery, radiation, and chemotherapy.
How Does It Work?
In cancer, the immune system often fails to recognize and combat cancer cells. DENVAX addresses this by deploying dendritic cells, specialized immune cells that correct the immune system’s oversight. Activated immune responses then traverse the body, targeting and destroying cancer cells.
Its Benefits
Functioning as an additional treatment plan, DENVAX complements surgery, radiation, and chemotherapy. It activates the immune system, contributing to a comprehensive, multi-disciplinary approach. Notably, it enhances the quality of life, extends lifespan, and yields improved clinical outcomes.
User-friendly and harmonious with other modalities, DENVAX proves safe and nearly non-toxic, making it an ideal choice for personalized cancer care. In stage IV cases, it serves as palliative therapy, providing comfort to patients.
Preparation Method
DENVAX preparation involves extracting the patient’s blood cells and transforming them into cancer-fighting dendritic cells. The initial dose is administered on the 10th day of blood collection, with subsequent doses given at 2-week intervals.
Starting Denvax Treatment
To initiate DENVAX treatment, patients or their representatives contact our office. After submitting reports and a brief video detailing the clinical status, our medical team assesses eligibility. Those opting for DENVAX sign an Informed Consent Form, and our logistics team coordinates blood collection from the patient’s home.
Manufacturing & Administration
The manufacturing process takes 8 days, and patients can choose to receive the dose at home or visit DENVAX clinics. Trained technical staff, along with the dose, is dispatched to the patient’s home. The staff ensures safe administration before leaving.
Safety Of Denvax
DENVAX stands out for its minimal adverse effects compared to chemotherapy. As an autologous treatment, it is safe, with only mild side effects like temporary fever in some cases. Experience the next frontier in cancer treatment with DENVAX, where safety and effectiveness converge for a brighter future.
Side-Effects of Lung Cancer Immunotherapy
Your healthcare team will share information about the potential side effects of the immunotherapy drug you’re receiving. They’ll guide you on managing these side effects and provide treatment options if needed.
While it’s uncommon, immunotherapy can occasionally prompt the immune system to mistakenly target other parts of the body, leading to more serious side effects in the lungs, organs like the liver or bowel, and hormone-producing glands. In such cases, treatment might have to be paused, and you may be prescribed steroids temporarily to calm your immune system.
In rare instances, these side effects may surface even up to 2 years after concluding the treatment, known as late effects. If you suspect any of these issues, it’s crucial to reach out to your cancer doctor or nurse without delay.
Immunotherapy drugs may cause some other side effects like tiredness, skin rash, itching, and stomach issues such as constipation or diarrhea. You might also feel nauseous, have a cough, lose your appetite, or experience joint pain. During immunotherapy, there’s a chance of an infusion reaction, similar to an allergy. This could lead to symptoms like fever, chills, coughing, wheezing, a rash, or itchy skin. It’s important to tell your care team right away if you notice any of these signs during your immunotherapy sessions.
These side effects highlight the need to keep a close eye on how you’re feeling and talk to your healthcare team about any discomfort. They’re there to help manage these reactions, ensuring you get the best out of your immunotherapy while keeping you safe and comfortable.
Your healthcare provider will walk you through these potential side effects, and it’s essential to keep them informed about any experiences you may have.
Also Read: Immunotherapy Side Effects
How is Immunotherapy For Lung Cancer Different From Other Lung Cancer Treatments?
Immunotherapy stands apart from traditional lung cancer treatments, such as chemotherapy, targeted therapy, and radiation, by employing a distinctive mechanism. In contrast to chemotherapy, which employs chemicals to indiscriminately kill or damage cancer cells along with healthy cells, immunotherapy takes a more nuanced approach. Rather than directly addressing mutations within tumors, immunotherapy targets the intricate communication pathways between the immune system and the tumor, aiming to enhance the body’s natural defenses against cancer.
Traditional chemotherapy, characterized by its systemic impact, often induces side effects like nausea, fatigue, and hair loss, in addition to compromising the white blood cell count and increasing susceptibility to infections. Targeted therapy, on the other hand, zeroes in on specific mutations present in certain lung cancer tumors, directing therapeutic interventions to the aberrant cellular processes driving uncontrolled tumor growth.
Meanwhile, radiation therapy utilizes potent X-rays or particles to either eradicate cancer cells or impede tumor growth. In contrast, immunotherapy represents a paradigm shift, orchestrating a response that leverages the immune system’s inherent ability to recognize and combat cancer cells. By modulating the immune-tumor interplay, immunotherapy holds promise as a more targeted and potentially less toxic approach to treating lung cancer.
Immunotherapy’s Promising Impact on Life Expectancy
Recent advances in immunotherapy for lung cancer have shown promising results in increasing life expectancy, according to a 2019 study in the Journal of Clinical Oncology (JCO). The study focused on the immunotherapy drug pembrolizumab, given every two to three weeks, which demonstrated extended survival for non-small cell lung cancer (NSCLC) patients, especially those with high levels of PD-L1 protein on their cancer cells who hadn’t received prior treatment.
The American Society of Clinical Oncology (ASCO) reported at its 2019 annual meeting that in this JCO trial of over 500 patients:
- 23 percent of untreated NSCLC patients showed positive responses five years later.
- Almost 16 percent of previously treated patients demonstrated favorable outcomes five years later.
A 2020 study in Thoracic Cancer compared outcomes of patients treated with immunotherapy to those receiving standard chemotherapy for advanced or metastatic NSCLC. It found that immunotherapy-treated patients had better overall survival.
Before the availability of immunotherapy, less than 6 percent of patients with metastatic NSCLC lived five years or more, as reported by ASCO. Immunotherapy has emerged as a promising treatment option, potentially extending life expectancy with fewer intense side effects compared to chemotherapy.
Your care team can provide guidance on available immunotherapy options tailored to your situation.
Final Note
Immunotherapy represents a groundbreaking approach in lung cancer treatment, providing significant strides in care. Differing from conventional methods like chemotherapy and targeted therapy, immunotherapy harnesses the body’s immune system to combat cancer cells.
With various types, including immune checkpoint inhibitors, cancer vaccines, and adoptive T cell therapy, it holds promise for improved outcomes. Although side effects exist, recent studies indicate positive impacts on life expectancy, showcasing the transformative potential of immunotherapy in the fight against lung cancer. Consult with your healthcare team for personalized guidance on available immunotherapy options.
