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Mary: Immunotherapy & Lung Cancer

Mary: Immunotherapy & Lung Cancer

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Immunotherapy and Lung Cancer

Immunotherapy is very new for treating lung cancer. Today, almost all lung cancer patients treated with immunotherapy have advanced cancers.

Right now, only two immunotherapy treatments are approved by the Food and Drug Administration (FDA). All other immunotherapy treatment options are available through clinical trials. If you are interested in immunotherapy, talk with your doctor about your options, including a clinical trial.

Types of Immunotherapy

Immune Checkpoint Inhibitors

Immune Checkpoint Inhibitors

One way cancer cells escape the immune system is to “fool” the body into turning its own defenses off. The ability to turn off is a necessary “checkpoint” that protects normal tissue from being attacked by the immune system--much like the brakes in a car.

Immune checkpoint inhibitors work either by preventing the tumor from putting on the brakes, or stimulating the immune response. Immune checkpoint inhibitors include:

PD-1 and PD-L1 Inhibitors

These drugs target an immune checkpoint found on T cells. Cancer cells can use the PD-L1 pathway to shut down T cells and hide from the immune system. These drugs block cancer cells from using this checkpoint and allow T cells to kill the cancer cells.

  • In 2015, nivolumab (Opdivo®) was the first PD-1 inhibitor approved for lung cancer. This treatment is used for patients with non-small cell lung cancer (NSCLC) who no longer respond after chemotherapy and EGFR or ALK targeted therapy (if their tumor has those genetic mutations). 
  • Pembrozulimab (Keytruda®) is approved for patients with NSCLC whose tumors test positive for the PD-L1 marker, and are negative for EGFR and ALK. This biomarker may help predict which patients will respond to this treatment.
  • Atezolizumab (Tencentriq®) is used for patients with NSCLC whose disease progressed after chemotherapy and EGFR or ALK targeted therapy (if their tumor has those genetic mutations). 
  • Avelumab (Bavencia®) was approved in 2017 to treat Merkel cell carcinoma and bladder cancer. It is being studied as a treatment for NSCLC.
  • Durvalumab (Imfinzi™) was approved in 2017 to treat bladder cancer. It is also being studied as a treatment for NSCLC.

CTLA-4 Inhibitors

  • These drugs work by activating T cells that can search for and destroy cancer cells. Ipilimumab (Yervoy®) is approved to treat advanced melanoma. It’s also being studied in a number of other tumors, including non-small cell lung cancer (NSCLC) and small cell lung cancers. In NSCLC, it is being studied in combination with chemotherapy. 

Therapeutic Vaccines

Therapeutic Vaccines

These drugs target “tumor specific antigens,” characteristics expressed by the cancer cells that mark them as different or abnormal. MAGE-3 is an antigen expressed in 42% of lung cancers and NY-ESO-1 in about 30% of lung cancers. These targets provide promising approaches for new lung cancer vaccines, but they are not the only ones. There are a number of potential targets, many of which are being tested in clinical trials today.

There are also currently trials to determine if vaccines can delay or prevent recurrence in people with lung cancers that are high risk to return or spread.

Adoptive T Cell Therapy

Adoptive T Cell Therapy

This is an approach in which T cells are removed from an individual with cancer then put through a special process that “re-engineers” them to seek out and destroy cancer cells. This technique has shown promising results in treating certain types of leukemia and lymphoma and is now being tested in a number of cancers, including lung cancer.

The Future of Immunotherapy for Lung Cancer

Personalized Therapy

Personalized Therapy

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There is tremendous excitement about the potential of immunotherapy to improve both the length and quality of life, but there is also a great deal of work to done and much to be learned about how these treatments work.

New approaches to treating lung cancer are offering hope and making a difference for people facing lung cancer. As researchers learn more about the ways in which the immune system interacts with lung cancers, there is promise for changing the possibilities for people with lung cancer