How is immunotherapy used to treat lung cancer?

Immunotherapy: New hope for lung cancer treatment. Below, learn about immunotherapy in treating lung cancer, understand how it impacts patients and see how you can help immunotherapy research efforts.

What are the types of lung cancer immunotherapy?

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 the immune system by displaying these checkpoints to stop the body from attacking them. Immunotherapy drugs can prevent the immune system from getting tricked and helps stimulate a response against cancer cells.

There are several drugs that target immune checkpoints that are approved for treatment of lung cancer. Many of these drugs block or "inhibit" the contact between the PD-L1 protein and the PD-1 receptor on the T cell. The PD-L1/PD-1 interaction functions as a brake that prevents the immune system from responding to cancer. By blocking this interaction, the immune system is able to recognize and attack cancer cells. One of these approved drugs targets another immune checkpoint called CTLA4. When CTLA4 is blocked, the body is able to ramp up the number of immune cells that are available to respond against cancer cells.

Checkpoint inhibitors are 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 by stimulating the immune system, it is possible to develop serious immune-related side effects from an over-stimulated immune system 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. These vaccines target proteins that are present in cancer cells that are either not present in normal cells or are only sparingly present in normal cells. Sometimes, the vaccines are customized to target proteins that are unique to an individual’s cancer. In other cases, the vaccines target cancer-specific proteins shared by many people. Before a vaccine is given, it is often necessary to first take a medicine to dampen the types of immune cells that may allow a cancer to grow and boost the types of immune cells that can respond to cancer. 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 are better at attacking your specific cancer cells. Finally, the enhanced T cells are put back into your body to help it fight cancer. Removing the T cells from your body can be done by a procedure called plasmapheresis which helps filter your blood to specifically identify certain types of blood cells. It can also be done by removing part of the tumor and separating T cells from the tissue. Right now, this type of therapy is being studied in clinical trials and no such treatment is FDA approved for treating lung cancer.

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 or particles to kill cancer cells or keep tumors from growing.

Immunotherapy doesn't address mutations in tumors. Instead, it targets the communication between the immune system and the tumor to help the immune system fight the cancer.

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 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.