Immunotherapy for Lung Cancer

It is a little-known fact that one of the reasons for the development of cancer is the immune system's inability to impair and eliminate cancerous cells. Unfortunately, some cancer cells have developed multiple mechanisms to evade the immune system's defenses. In 2016, the American Society of Clinical Oncology (ASCO) named immunotherapy the clinical cancer advancement of the year. This breakthrough treatment offers a glimmer of hope to cancer patients, as it works in tandem with other cancer treatments to combat the disease. This article offers insights into immunotherapy and how it can be used against lung cancer. This information may also be useful to patients who already have immunotherapy as part of their treatment plan.

The immune system is a complex network of cells, tissues, and molecules that work together to defend the body against harmful invaders, such as viruses, bacteria, and cancer cells.

Immunotherapy is a systemic treatment that works throughout the entire body, rather than targeting a specific localized area. It harnesses the body’s own immune system to fight cancer. It enhances or stimulates the immune system's natural ability to recognize and destroy these harmful cells.

To treat lung cancer, doctors prescribe immunotherapy

• To treat advanced or metastatic lung cancer – stage 3 and 4 non-small cell lung cancer and small cell lung cancer
• Based on PD-L1 status – level of PD-L1 helps to predict response to certain immunotherapeutic drugs and the need for monotherapy or combined therapy (i.e. chemoimmunotherapy)
• In combination with other therapy (radiation or chemotherapy) to
  • Delay tumor resistance to any treatment in the personalized therapy
  • Improve treatment outcome by targeting different aspects of cancer progression
  • Address the fact that there may be a mixture of different cancer cell types (adenocarcinoma and squamous cells) in tumors
  • Kill the cancer cells before they turn aggressive and spread
• As adjuvant therapy to eliminate any remnant cancer cells from initial treatment like radiation therapy and surgery, undetected by scans. Only for advanced-stage patients with high risk of recurrence.
• As neoadjuvant therapy – especially in cases where the tumor is slightly bigger, chemotherapy can shrink the tumor before surgery. The addition of immunotherapeutic agents to neoadjuvant chemotherapy improves patient response, thereby reducing the duration of neoadjuvant therapy and lessening potential toxicities.
• Treatment by cell types – for patients without driver mutations (treated by targeted therapy).
• To treat cancer progression – for patients with driver mutations, immunotherapy is sometimes integrated with the targeted therapy
• As maintenance therapy – to delay cancer relapse for as long as possible

• Individuals with autoimmune diseases
• Individuals on other immunosuppressive agents
• Individuals who are too ill/frail
• Individuals who experience severe toxicities after immunotherapy
• Individuals who progress despite immunotherapy

Sanda Cohen was told that she had only six to nine months left when she was diagnosed with stage IV lung adenocarcinoma. Despite the advanced-stage cancer, her genetic tests showed she could benefit from immunotherapy. She received a combination of chemo- and immunotherapy (pembrolizumab, Keytruda®) every three weeks through a chemo port. She experienced fatigue, nausea, anemia and rashes from the cancer treatments. After 3 months, the treatments managed to reduce her tumor by half. She had also received stereotactic body radiation therapy (SBRT). Eventually, her doctor discontinued the chemo drug and she continued with immunotherapy as a maintenance treatment. Thanks to immunotherapy, Sanda’s life was extended, and she had the joy of welcoming two grandchildren. She remains immensely grateful for this outcome. Sanda's story is an inspiring example of how one can overcome cancer through resilience, and it offers hope that ongoing progress in cancer research will yield positive results.

Read next: Immunotherapeutic Drugs for Lung Cancer Treatment and How They Work