Immunotherapy for lung cancer

This page was reviewed under our medical and editorial policy by

Sagun Shrestha, MD, Medical Oncologist and Hematologist

This page was reviewed on September 30, 2022.

Your immune system cells detect and fight infections throughout the body. Immunotherapy drugs help the immune system find and attack any cancer cells that may be evading detection.

Immunotherapy drugs for lung cancer focus on the way cancer cells and your immune system cells communicate via the proteins on their surfaces. Some immunotherapy drugs disrupt the receptors on immune cells, making them more sensitive to foreign substances—like cancer cells—and more responsive so they can fight them. Other drugs disrupt the proteins on the cancer cell surface, making it harder for these to hide from your immune system.

How does immunotherapy work for lung cancer?

Your immune system consists of different types of cells that work together to look for foreign infections in your body. They recognize certain substances as threats and others as safe through the interaction between a protein on the surface of the foreign substance and a protein on the immune cell. Once the immune cell recognizes the foreign cell as safe, it can move through your body without a problem.

Some cancer cells can outsmart your immune system by using a protein on their surface that makes them look safe. That’s where immunotherapy comes in. Immunotherapy drugs help your immune system recognize cancer cells even when they’re trying to hide.

Most lung cancer immunotherapy drugs approved by the U.S. Food and Drug Administration (FDA) work by disrupting the interaction between the PD-L1 protein on cancer cells and the PD-1 receptor on immune T-cells. Another immunotherapy drug disrupts the CTLA-4 protein on immune T-cells. When these connections are broken, T-cells are better able to recognize cancer cells and respond to them.

Types of immunotherapy for lung cancer

Checkpoint inhibitors

Checkpoint inhibitors stop cancer cells from hiding from your immune system. They help your immune system recognize cancer cells and fight them, which can slow or stop tumor growth.

The FDA has approved three main types of immune checkpoint inhibitors for lung cancer. These inhibitors are named for the proteins they affect on the surface of cancer or immune system cells:

  • PD-1 inhibitors, including Opdivo® (nivolumab), Keytruda® (pembrolizumab) and Libtayo® (cemiplimab-rwlc). These drugs block the PD-1 protein on T-cells and help these cells recognize cancer cells.
  • PD-L1 inhibitors, including Tecentriq® (atezolizumab) and Imfinzi® (durvalumab). These drugs affect the PD-L1 protein on the surface of some cancer cells and immune system cells. Your care team may test the cancer cells to see the amount of PD-L1 protein on their surface in order to assess how well this type of inhibitor might work.
  • CTLA-4 inhibitor, including Yervoy® (ipilimumab). Yervoy boosts your immune response against cancer cells by affecting the CTLA-4 protein on T-cells, letting these cells know they should fight the cancer cells.

Monoclonal antibodies

Monoclonal antibodies (mAbs or MoAbs), also in the category of targeted therapy, are man-made antibody proteins. Some of them behave like immunotherapy drugs by mimicking immune system proteins, attaching to antigens in cancer cells and affecting blood vessel growth. In this way, they help your immune system respond to and attack cancer cells. Two examples used in the treatment of non-small cell lung cancer (NSCLC) include Avastin (bevacizumab) and Cyramza (ramucirumab).

Other type of immunotherapy

In addition to checkpoint inhibitors and certain monoclonal antibodies, other promising immunotherapy treatments, such as cancer vaccines and adoptive cell therapies, also work with your immune system to fight cancer and are being studied in clinical trials.

Immunotherapy for non-small cell lung cancer

The following immunotherapy drugs can be used for NSCLC:

  • Tecentriq
  • Libtayo
  • Imfinzi
  • Yervoy
  • Opdivo
  • Keytruda

Immunotherapy for small cell lung cancer

The following immunotherapy drugs are used for small cell lung cancer (SCLC):

  • Tecentriq
  • Imfinzi
  • Opdivo
  • Keytruda

How are immunotherapy drugs given?

Your care team will administer your immunotherapy drugs through an intravenous (IV) line into your vein, typically at an outpatient clinic. This is called an infusion or, more specifically, an immunotherapy infusion. You will likely undergo an immunotherapy infusion once every few weeks. The exact timing will depend on the drug, or drugs, that are part of your treatment plan. Some drugs require infusions once every two weeks, while others require infusions less often, such as once every four or six weeks.

You will keep getting immunotherapy infusions as long as your care team sees that they are working successfully against the cancer.

Immunotherapy and chemotherapy combination

In cases of advanced SCLC, the checkpoint inhibitors Tecentriq and Imfinzi can be used along with certain chemotherapy drugs as an initial treatment—and they may be continued after chemotherapy as a maintenance treatment.

For advanced NSCLC patients, Keytruda, Tecentriq or Libtayo can sometimes be paired with chemotherapy as an initial treatment. The checkpoint inhibitors Opdivo and Yervoy may also be paired with chemotherapy as an initial treatment.

Researchers have been studying the effect of immunotherapy after other therapies—called adjuvant immunotherapy—for NSCLC. In 2021, Tecentriq was approved by the FDA for use after surgery and chemotherapy for NSCLC in some cases. Immunotherapy as adjuvant treatment after surgery and chemotherapy may help prevent cancer from returning.

Side effects of immunotherapy for lung cancer

Immunotherapy drugs tend to have less serious side effects than chemotherapy, but they can still affect how you feel. Different types of immunotherapy drugs can cause different side effects—not to mention that individual responses to immunotherapy may differ.

Side effects from immunotherapy drugs may include:

  • Fatigue
  • Skin rash
  • Itching
  • Gastrointestinal issues such as constipation and diarrhea
  • Nausea
  • Cough
  • Loss of appetite
  • Joint pain

Some people may have an infusion reaction during immunotherapy, which is similar to an allergic reaction. It can include fever, chills, coughing, wheezing, a rash or itchy skin. Inform your care team right away if you notice any of these symptoms while undergoing immunotherapy.

It’s also possible for your immune system to start attacking other parts of your body due to immunotherapy, not just cancer cells. This is called an autoimmune reaction, and it could affect your lungs, liver, kidneys and other organs.

Be sure to tell your care team about any side effects you have, either during your therapy or at home afterward. They may be able to help you manage them.

Life expectancy after immunotherapy for lung cancer

Many clinical trials are underway to identify new ways of using immunotherapy to treat lung cancer, and recent breakthroughs have improved the success of immunotherapy treatments.

A 2019 study in the Journal of Clinical Oncology (JCO) suggests that the immunotherapy drug pembrolizumab given every two to three weeks could increase life expectancy for some NSCLC patients, particularly those with high levels of PD-L1 protein on their cancer cells and who haven’t yet had any cancer treatment. The study showed extended survival, and the results were promising, even for patients with high PD-L1 levels who had undergone a previous cancer treatment. The American Society of Clinical Oncology (ASCO) reported at its 2019 annual meeting that this JCO trial of more than 500 patients showed the following:

  • 23 percent of NSCLC patients who had not been previously treated with other systemic treatments were alive five years later
  • Almost 16 percent of patients who were previously treated were alive five years later

A 2020 study in Thoracic Cancer looked at the outcomes of patients treated with immune checkpoint inhibitors for advanced or metastatic NSCLC compared with those who received standard chemotherapy. It found that those treated with immunotherapy had better overall survival.

Before immunotherapy became available, less than 6 percent of patients with metastatic NSCLC lived five years or more, according to the ASCO. It’s clear that immunotherapy treatment has the potential to extend life expectancy.

Your care team can help guide you through immunotherapy options. These options have the potential to extend your life and confer fewer intense side effects than chemotherapy treatment.

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