Immunotherapy

Immunotherapy is a type of drug used to treat cancer. Several immunotherapies are approved to treat lung cancer. They boost your body’s immune system to fight cancer cells.^1,2

You may take only 1 immunotherapy drug or a combination. You may also take immunotherapies in combination with other treatments. Serious side effects are possible. Talk to your doctor about the risks and benefits of immunotherapy.^1-3

How does immunotherapy work?

Immunotherapy drugs help your immune system destroy cancer cells. Your immune system protects you from harmful bacteria and viruses. It should attack things that do not belong in your body. It should not attack normal, healthy body cells.^3-5

Cancer cells are harder for the immune system to detect. Cancer cells were once normal, healthy cells. But cancer cells developed features that make them harmful. They can trick the immune system to protect themselves. Immunotherapy drugs help the immune system identify the cancer cells.^4,5

They do this by blocking proteins that protect cancer cells from the immune system. These proteins are called immune “checkpoints.” Cancer cells can use these checkpoints to protect themselves. Some checkpoints that immunotherapy drugs block include:^1-5

• PD-1 (programmed cell death protein 1) – protein on certain immune cells (T cells) that keeps them from attacking cells
• PD-L1 (programmed death-ligand 1) – protein on cancer cells and certain immune cells that binds to and activates PD-1
• CTLA-4 (cytotoxic T-lymphocyte associated protein 4) – protein on T cells that also keeps them from attacking cells

Blocking these immune checkpoints boosts immune activity against cancer cells. This can shrink tumors or slow cancer growth. Experts are testing other types of immunotherapies. For example, cancer vaccines and adoptive T-cell therapy are in clinical trials for lung cancer.^1,4-6

Examples

Several immunotherapy drugs are approved to treat certain forms of lung cancer. They are classified by the immune checkpoint they block.^1-3

Examples of PD-1 blockers include:^7-9

• Opdivo^® (nivolumab)
• Keytruda^® (pembrolizumab)
• Libtayo^® (cemiplimab)

Examples of PD-L1 blockers include:^10,11

• Tecentriq^® (atezolizumab)
• Imfinzi^® (durvalumab)

Examples of CTLA-4 blockers include:^12,13

• Yervoy^® (ipilimumab)
• Imjudo^® (tremelimumab)

Your doctor will suggest the immunotherapy you should use based on your cancer type and stage, lab test results, and other factors. For example, in some situations, you must have enough of certain tumor proteins for those blockers to work.^1,2

PD-1, PD-L1, and CTLA-4 inhibitors can be used to treat certain forms of non-small cell lung cancer (NSCLC). Some are used alone or with other drugs as a first treatment option. Others may be used when other treatments do not work and/or NSCLC is advanced. The PD-L1 inhibitors can be combined with chemotherapy, and tarlatamab can be used alone, to treat certain forms of small-cell lung cancer.^1,2

What are the possible side effects?

Side effects can vary depending on the specific drug you are receiving. The risk of side effects is different if you receive more than 1 drug. Common side effects of certain immunotherapies include:^1,2,5

• Fatigue
• Cough
• Nausea, loss of appetite, constipation, or diarrhea
• Itching or skin rash
• Muscle, joint, or bone pain

More serious side effects are possible. Immunotherapies can cause autoimmune reactions. This is because they block safeguards on your immune system. This can cause your immune system to attack normal, healthy cells. These attacks can cause serious problems in the lungs, liver, intestines, and other organs.^1,2

Immunotherapies can also cause serious infusion reactions. These are similar to an allergic reaction. Talk to your doctor if you notice any symptoms, including:^1,2

• Fever
• Chills
• Flushing of the face
• Rash or itchy skin
• Feeling dizzy
• Wheezing or trouble breathing

These are not all the possible side effects of immunotherapy drugs. Talk to your doctor about what to expect when receiving immunotherapy drugs. You also should call your doctor if you have any changes that concern you when receiving immunotherapies.

Other things to know

Immunotherapies are given as an infusion into the vein or an injection under the skin. You may receive the drug once every few weeks. Your doctor will talk to you about your treatment schedule.^1,2

Immunotherapies are often combined with other treatments. For example, CTLA-4 blockers are not used alone in lung cancer treatment. They are only used with a PD-1 or PD-L1 blocker, depending on the specific medicine. Immunotherapies are often used during or after chemotherapy. Some can be used before or after surgery.^1,2

Before beginning treatment for lung cancer, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

Having other conditions or taking certain other drugs with immunotherapies can potentially increase your risk of side effects. Tell your doctor about:^7-13

• Any allergies
• Immune system problems, such as Crohn’s disease, ulcerative colitis, or lupus
• Nervous system conditions, such as myasthenia gravis
• History of organ or stem cell transplants
• History of radiation treatments
• Pregnancy or plans to become pregnant
• Breastfeeding or plans to breastfeed