Learn: What exactly is immunotherapy? Is every lung cancer patient a candidate for immunotherapy?

Can my own immune system kill my lung cancer?

Learn the basics about immunotherapy for lung cancer in this discussion between patient advocate Lisa Goldman and Dr. Jonathan Goldman from the Ronald Reagan UCLA Medical Center.

About

One of the most powerful mechanisms in the human body is the immune system. It’s job is fighting disease within the body that should not be there. Yet, cancer can be really smart and fool the body’s immune system into thinking cancer cells should not be attacked by the immune system.

In the past few years, lung cancer research has discovered new therapies that teach the immune system to recognize cancer cells as bad cells that need to be destroyed. Immunotherapy for lung cancer allows the immune system to do its work in battling cancer.

More recently, by evaluating what strategies cancer cells use to evade an individual’s immune system, drugs have been developed to overcome this evasion or modify the body’s immune response to the presence of cancer. This type of treatment is referred to as immunotherapy.

The immune system within our bodies is very powerful. But, cancer cells find ways to hide from the immune system. In the past few years, scientists have found medications that can be used to stop cancer cells from being able to hide from the immune system and allow it to do its work in battling the cancer.

Types of Treatment

Our immune systems work around the clock protecting our bodies from “foreign” substances such as bacteria and viruses. We know that this immune “surveillance” also protects us from cancer, by recognizing a cell that has become cancerous as something foreign. When this surveillance system fails, cancers begin to grow. An everyday example of this process occurring naturally is in the case of pregnancy…this is the mechanism by which a fetus can grow in a woman’s body without being identified as foreign and hence being attacked.

“Cancer cells are the teenagers of cells… they’re pretty normal, but they behave badly.”

– Dr. David Johnson

Spontaneous mutations in the genes of a cancer cell cause the cells to be altered in such a way that they can no longer be recognized by our bodies as something foreign. They can also produce substances or proteins that can shield them from immune attack, as outlined below.

There are several types of immunotherapy for cancer, but the approach has proven to be effective in both non small cell lung cancer (NSCLC) patients, and small cell lung cancer (SCLC) patients. Immunotherapies are drugs that work on immunologic checkpoints which are a normal part of the immune system. Their role is to prevent an immune response from being so strong that it destroys healthy cells in the body.

PDL-1

A patient’s cancer cell can have on its surface a complex molecule that activates the PD-1 receptor on a patient’s T-cells. PDL-1 is a protein that acts as a kind of “brake” to keep the body’s immune responses under control. Drugs known as “ANTI-PD-L1” break that bond which then allows the tumor cells to be attacked by T-cells.

A very important finding about immunotherapy is that when a patient responds to the treatment, the response can last longer than conventional chemotherapy. Scientists are studying why some patients’ cancers respond, as well as why other patients’ cancers do not. Combinations of these drugs with chemotherapy and/or other targeted therapies are also being investigated and several combinations have been approved by the Federal Drug Administration (FDA) for treatment for certain NSCLC and SCLC patients.

Many lung cancer patients, both SCLC patients and NSCLC patients might benefit from immunotherapy. There are combinations of immunotherapy and chemotherapy that are effective as a first line therapy for certain NSCLC lung cancer patients. There are some SCLC patients with extensive stage disease who will benefit from immunotherapy either alone or in combination with chemotherapy. Clinical trials are ongoing and new, effective treatments are being tested, evaluated and approved by the FDA regularly. Ongoing research and innovation in science and technology has led to significant progress for all forms of lung cancer.

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What to Expect

Immunotherapy has emerged as a promising treatment option for lung cancer. It works by harnessing the body’s immune system to fight cancer cells. Understanding what to expect from immunotherapy treatment can help patients and their families navigate this innovative approach to lung cancer care. Here are some key points to consider:

  • How Immunotherapy Works: Immunotherapy drugs, such as immune checkpoint inhibitors, target specific proteins on cancer cells or immune cells to enhance the body’s immune response against cancer. By blocking these proteins, immunotherapy drugs help unleash the immune system’s ability to recognize and attack cancer cells.
  • Eligibility for Immunotherapy: Not all patients with lung cancer are eligible for immunotherapy. The decision to undergo immunotherapy depends on various factors, including the type and stage of lung cancer, as well as the presence of specific biomarkers. Your healthcare team will assess your individual case to determine if immunotherapy is a suitable treatment option.
  • Potential Benefits: Immunotherapy has shown remarkable results in some lung cancer patients. It can lead to long-lasting responses, with some individuals experiencing a significant reduction in tumor size or even complete remission. Additionally, immunotherapy may offer a more tolerable side effect profile compared to traditional treatments like chemotherapy.
  • Treatment Schedule: Immunotherapy for lung cancer is typically administered intravenously, either as a standalone treatment or in combination with other therapies. The treatment schedule varies depending on the specific drug and individual patient factors. Your healthcare team will provide detailed information on the duration and frequency of your immunotherapy sessions.
  • Monitoring and Follow-Up: Regular monitoring is essential during immunotherapy treatment. Your healthcare team will conduct frequent check-ups, including imaging scans and blood tests, to assess the response to treatment and monitor for any potential side effects. It is important to attend all scheduled appointments and report any concerns or changes in your health.

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Side Effects

Immune checkpoint inhibitors (also called immunotherapy) can cause side effects that affect patients in different ways. Common immunotherapy side effects include:

  • Rash
  • Diarrhea
  • Fatigue

Discuss possible side effects with your doctor.

FDA-Approved Immunotherapy Treatment

Types
  • Nivolumab (Opdivo/Opdivo Injection)

    FDA approved nivolumab with platinum-doublet chemotherapy for adult patients with resectable non-small cell lung cancer (NSCLC) in the neoadjuvant setting.

    Approved for: NSCLC

    FDA Approval Date: 03/01/2022

    Used in: Immunotherapy

  • Cemiplimab-rwlc

    NSCLC patients tumors with high PD-L1 expressoin and without EGFR, ALK, ROS1 aberrations

    Approved for: NSCLC

    FDA Approval Date: 02/23/2024

    Used in: Immunotherapy

  • Pembrolizumab (Keytruda)

    Small cell lung cancer that has metastasized. It is used in patients whose disease got worse during or after treatment with platinum chemotherapy and at least one other therapy.

    Approved for: SCLC

    Biomarkers: SCLC

    FDA Approval Date: 03/01/2020

    Used in: Immunotherapy