Lung Cancer Immunotherapy | American Lung Association

Lung Cancer Immunotherapy

illustration of woman with icons in circleNeed a visual? Use our interactive lung cancer immunotherapy infographic as a visual guide to help you better understand this important emerging treatment option.

Immunotherapy uses medicine to activate your own immune system to recognize and kill cancer cells. So far, immunotherapy only has been approved to treat advanced non-small cell lung cancer (NSCLC). However, research is advancing every day. You may be eligible for a clinical trial that tests a new type of immunotherapy drug. Ask your doctor if a clinical trial is right for you.

Below, get answers to common questions about lung cancer immunotherapy, see how it impacts patients and learn how you can help immunotherapy research efforts.

What You Need to Know About Lung Cancer Immunotherapy

From how it works to who is eligible to possible side effects, get answers to your questions about lung cancer immunotherapy.

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Supported by an educational grant from Merck.

What is immunotherapy?

Immunotherapy for cancer, sometimes called immune-oncology, is a type of medicine that treats cancer using the body's own immune system. Your immune system protects you from harmful agents like bacteria and viruses. When it is working well, it attacks what shouldn't be in your body. The immune system also does a good job of keeping your body from attacking things that should be there. Immunotherapy drugs for lung cancer help your body recognize the cancer as foreign and harmful so your body can fight it.

What are the types of lung cancer immunotherapy?

There are three main types of immunotherapies being studied in people with NSCLC:

1. Immune checkpoint inhibitors

The most progress in immunotherapy for lung cancer has been made in immune checkpoint inhibitors. Immune checkpoints are molecules on the immune cells that can start or stop an immune response. The immune system uses these molecules to help determine what is normal and what should be attacked. Cancer cells sometimes trick these checkpoints to stop the body from attacking them. Newer drugs can target these checkpoints and help them respond against cancer cells.

There are several FDA-approved lung cancer immunotherapy drugs for patients with advanced stage non-small cell lung cancer. There are more options within immunotherapy than ever before. There are now first-line, second-line and combination immunotherapy treatments available. Each drug has specific indications based upon the type of lung cancer you have, whether or not you have any mutations or biomarkers, what treatment (if any) you have tried in the past and your general health. Work with your doctor to understand your options.

These types of drug block or "inhibit" the contact between the PD-L1 protein and the PD-1 receptor on the T cell (see our infographic to learn more about how this works).  This helps boost the immune response against cancer cells. They are normally given as an intravenous (IV) infusion. These drugs can have similar side effects to chemotherapy, including fatigue, nausea, itching, skin rash, and more, but they are generally less toxic than chemotherapy. However, because the drugs work on the immune system, it is possible to have serious immune-related side effects that can affect how your organs function. It is important to work with your care team to help monitor all side effects.

2. Cancer vaccines

When most people think of vaccines they think of treatments that prevent disease. However, there is another type of vaccine called a therapeutic vaccine. This type of vaccine treats an existing cancer by making the immune system better at killing cancer cells. Right now, these vaccines are being studied in clinical trials. There is currently no FDA-approved vaccine for lung cancer treatment.

3. Adoptive T cell therapy

In this therapy, T cells (a type of white blood cell in the immune system) are removed from your body and then altered in a laboratory so they better attack cancer cells. Finally, the enhanced T cells are put back into your body to help it fight cancer. Right now, this type of therapy is being studied in clinical trials and no such treatment is FDA approved for treating lung cancer.

How does it work?

The immune system is made up of cells, tissues and organs that communicate with each other to protect the body. Your immune system uses different ways to talk to other cells to gather information about whether to attack an invader or leave it alone.

One way your immune system communicates is through connections between molecules on the surface of immune cells (like T lymphocyte cells also known as T cells) and foreign cells (like cancer cells).

Cancer cells have found ways to keep the immune system from destroying them. One way some cancer cells do this is by producing a protein called PD-L1. This protein binds to PD-1 receptors on T cells and turns them off. This prevents them from killing the cancer cell.

Current FDA-approved lung cancer immunotherapy drugs work to stop the cancer cells from turning off the T cells. Approved drugs either target the PD-L1 protein or the PD-1 receptor. No matter which they target, they have the same goal of blocking or "inhibiting" the contact between the PD-L1 protein and the PD-1 receptor on the T cell. This re-activates the T cells and turns the immune system back on, helping it fight the cancer. There are other drugs in immunotherapy clinical trials for lung cancer. Some of these drugs target other pathways in the immune system.

How are these drugs given?

These drugs are given through an IV into your veins. This is called an infusion. Patients get infusions every few weeks. Most patients stay on immunotherapy for several months. Some patients may stay on for longer or shorter periods of time, depending on their side effects. Immunotherapy drugs have been shown to keep working for a period of time even after treatment is stopped.

Who is eligible for immunotherapy?

There are several FDA-approved lung cancer immunotherapy drugs for patients with advanced stage non-small cell lung cancer. There are more options within immunotherapy than ever before. There are now first-line, second-line and combination immunotherapy treatments available. Each drug has specific indications based upon the type of lung cancer you have, whether or not you have any mutations or biomarkers, what treatment (if any) you have tried in the past and your general health. Work with your doctor to understand your options.

How is immunotherapy different from other lung cancer treatments?

Immunotherapy works differently than other lung cancer treatments like traditional chemotherapy, targeted therapy and radiation.

Traditional chemotherapy uses chemicals to kill or damage cancer cells. These drugs can affect healthy cells too. This can cause side effects like nausea, fatigue and hair loss, lowering of the white blood cell count and possible infection.

Targeted therapy focuses on mutations that are in some lung cancer tumors. These therapies attack specific targets on or in the tumor cells that are causing the tumor to grow uncontrollably.

Radiation therapy uses powerful, high-energy X-rays to kill cancer cells or keep tumors from growing.

Immunotherapy is more specific and precise than traditional chemotherapy. However, it doesn't address the mutations in the tumors. Instead, it targets the communication between the immune system and the tumor to help the immune system fight the cancer.

Do I need to be in a clinical trial to receive immunotherapy?

You do not need to be in a clinical trial to receive an FDA-approved immunotherapy drug. However, there are promising lung cancer immunotherapy drugs currently in clinical trials. Participating in one of these trials might be the right treatment choice for you. Talk to your doctor about the clinical trials available to you.

What are some possible side effects?

All cancer treatments have possible side effects. When taking immunotherapy, some people experience very few side effects, while others have more serious complications. Some of the most common side effects of immunotherapy drugs are:

Immunotherapy may also cause inflammation in the organs of the body. Inflammation can happen in any organ of the body including: lung (pneumonitis), liver (hepatitis), colon (colitis/diarrhea) or thyroid gland. This can be very serious, and all possible side effects should be discussed with your doctor before you begin the drug.

How do I cope with these side effects?

It is best to work very closely with your doctors and nurses to manage your side effects. Some side effects can be treated with over-the-counter medication. Other side effects may require prescription drugs or even time spent in the hospital. If side effects are managed early, it is easier to avoid major problems. If your side effects are well managed, it may also allow you to take only a short break or stay on the immunotherapy medication longer.

Ask about being connected with a palliative care team. Palliative care teams are made up of doctors, nurses and other healthcare professionals who are specially trained to help you manage your side effects and maintain a good quality of life.

Will immunotherapy work well for me?

Some patients have responded very well to immunotherapy, while others do not have the same positive response. No one can predict how your body will respond to any one treatment. Work with your doctor to understand what you can expect while on an immunotherapy drug, and if it is the right choice for you.

Immunotherapy: New Hope for Lung Cancer Treatment

Video: Dr. Mary Jo Fidler and lung cancer survivors, Karen and Donna, talk about the hope of lung cancer immunotherapy. [Watch in Spanish.Supported by an educational grant from Merck.

Research

Take Action

You can help advance immunotherapy research. Join the Lung Cancer Registry to help researchers learn from patients on immunotherapy. Visit LungCancerRegistry.org to get started.

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    What You Need to Know About Lung Cancer Immunotherapy

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    Immunotherapy: New Hope for Lung Cancer Treatment

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    Approved by Scientific and Medical Editorial Review Panel. Last reviewed November 26, 2017.

    Last updated June 1, 2017.

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