Immunotherapy and Lung Cancer
Immunotherapy is the newest approach to treating lung cancer. Some people with advanced lung cancers have had very significant shrinkage of their tumors that lasts for a long time. On the other hand, not all lung cancers respond to this treatment. There are many different types of lung cancer, and big differences between each person’s tumors. Research is aiming to learn why some lung cancers respond to immunotherapy better than others and how to find the best therapy for each person’s tumor.
In lung cancer, immunotherapy has only been approved for most types of non-small cell lung cancer (NSCLC) and will likely soon be approved for small cell lung cancer. All other immunotherapy treatment options are available through clinical trials. Data is starting to show promise for immunotherapy with small cell lung cancer (SCLC).
If you are interested in immunotherapy, talk with your doctor about your options.
Types of Immunotherapy
Immune Checkpoint Inhibitors
Immune Checkpoint Inhibitors
The immune system has safeguards to prevent it from attacking healthy cells. These safeguards are called checkpoints. They slow down or stop an immune system attack when healthy tissue is threatened. Some cancers have learned how to activate these checkpoints to avoid being attacked. New drugs, called checkpoint inhibitors, are designed to turn off these check- points and help the body fight cancer.
PD-1 and PD-L1 Inhibitors
Most patients who receive immunotherapy today have advanced (metastatic) disease and are on one of two kinds of checkpoint inhibitors: PD-1 and PD-L1 Inhibitors. These inhibitors are antibodies that stop the tumor from turning off T cells (the immune system’s “soldiers”). When cancer cells use the PD-L1 checkpoint to shut down T cells, they can “hide” from the immune system. These antibodies block cancer cells from using this checkpoint, so they aren’t “hidden.” This allows your T cells to find and 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). It is also approved for bladder cancer, melanoma, kidney cancer, and head and neck cancer.
- Pembrozulimab (Keytruda®) can be used for patients with NSCLC that tests negative for EGFR and ALK and positive for PD-L1. If you have already had chemo, it can be used for NSCLC that tests positive for PD-L1, no matter what your EGFR and ALK status. It can also be used with chemotherapy to treat NSCLC that tests negative to PD-L1. This drug is also used for any tumor that tests positive to MSI-H or dMMR and some other cancers like head and neck cancer, Hodgkin lymphoma, and melanoma.
- Atezolizumab (Tecentriq®):
- Is used for advanced non-squamous non-small cell lung cancer that is EGFR- or ALK-
- Is used for advanced NSCLC for which platinum chemotherapy did not work or stopped working (and, if EFGR+ or ALK+, the targeted therapy did not work or stopped working)
- Is used for advanced small cell lung cancer
- This drug is often given at the same time as chemotherapy drugs carboplatin, paclitaxel, or etoposide. May be given with bevacizumub, a drug that targets blood vessel growth
- Durvalumab (Imfinzi™) is approved when NSCLC cannot be removed by surgery and has responded to chemoradiation.
- 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 (SCLC). In NSCLC, it is being studied with chemotherapy and other immunotherapies. Tremelimumab is another CTLA-4 inhibitor being tested.
Other Monoclonal Antibodies
Checkpoint inhibitors are one type of monoclonal antibody. Other types let the immune system find and destroy cancer cells using targets that aren’t checkpoints. Still others take radiation or chemotherapy drugs directly to cancer cells. Not all monoclonal antibodies are immunotherapies. Monoclonal Antibodies that are targeted therapies include: bevacizumab (Avastin®), ramucirumab (Cyramza®), and necitumumab (Portrazza®).
To learn more, see our lung cancer book.
Cancer Vaccines are designed to “teach” T-cells to respond to specific tumor antigens. Several are being tested in lung cancer clinical trials. Current trials are seeing if vaccines can delay or prevent cancer from returning. This could help patients whose lung cancer is at high risk to return or spread. There are also trials to treat people with advanced disease. As with other types of immunotherapy, vaccines are still a new approach.
If you are interested in being treated with a lung cancer vaccine, talk to your doctors about clinical trial options.
Adoptive T Cell Therapy
Adoptive T Cell Therapy
In adoptive T cell therapy, T cells are removed from a person with cancer, taken to a lab, and modified. Once returned to the person, these modified T cells can find and destroy cancer. This is now being tested in several types of cancer, including lung. One type of adoptive T cell therapy, CAR T cell therapy, is approved to treat certain types of leukemia and lymphoma.
For information on CAR T, see our booklet.
The Future of Immunotherapy for Lung Cancer
New approaches to treatment with new knowledge about how the immune system interacts with cancer, offers hope and is making a huge difference for lung cancer patients
There is tremendous excitement about the potential for immunotherapy to improve a patient’s quality of life, longer. Yet, there is still a great deal of work to be done and much to be learned about these treatments.