Immunotherapy for Lung Cancer

Immunotherapy can be used to teach the body’s immune system to recognize and fight some forms of lung cancer cells. This means the body will be fighting cancer with its natural defenses, in contrast to treatments like chemotherapy and radiation therapy, which destroy cells.

Whether immunotherapy for lung cancer will work for a particular patient will depend on many factors, including the various characteristics of the cancer and its spread.

Keep reading to learn more about the main immunotherapy drugs for lung cancer, how they work, and how they are used to treat the different types and stages of lung cancer.

What is Immunotherapy for Lung Cancer?

Immunotherapy (or immune-oncology) for lung cancer is a type of drug that works by teaching the immune system to identify and destroy cancer cells.

The immune system can easily miss cancer cells because they start as healthy cells and the patient's DNA is part of those cells. Cancer cells can also produce a protein that tells the immune system not to fight them. This means the immune system does not always recognize cancer cells as a problem. The cancer cells essentially hide from the immune system.

Immunotherapy drugs for cancer signal to the immune system that the cancer cells need to be destroyed. This is different from other treatments, such as radiation, targeted therapy, and chemotherapy, which fight cancer cells or prevent cancerous tumors from growing.

Checkpoint Inhibitors

The body has checkpoints where cancer cells come into contact (bind) with proteins on the surface of immune system cells. These checkpoints help to prevent the immune system from fighting healthy cells. However, cancer cells can hide from the immune system at these checkpoints and invade healthy cells.

Instead of the cancer cells escaping the immune system, checkpoint inhibitors activate an immune response. Essentially, these drugs release the brake cancer cells put on the immune system. Subsequently, the activated immune cells attack the cancer cells. The immune system then knows to fight the cancer cells. Checkpoint inhibitors may be used with chemotherapy or alone and may be needed for maintenance therapy.

Non-Small Cell Lung Cancer

Checkpoint inhibitors can be used as a treatment for non-small cell lung cancer, or NSCLC. Immune cells called T cells attack what they identify as being harmful.

Some T cells have proteins called PD-1 or CTLA-4 that prevent them from attacking cells, including cancer cells. PD-1 inhibitors and CTLA-4 inhibitors are immunotherapy drugs that target or block these proteins so the T cells fight the cancer cells.

PD-1/PD-L1 Inhibitors

PD-1 inhibitors are intravenous (IV) infusion drugs that target the PD-1 proteins on T cells. They stop the proteins from preventing the T cells from fighting the cancer cells. This provides the immune system with a boost to shrink some tumors or slow their growth rates.

PD-L1 inhibitors are intravenous infusion drugs that target the PD-L1 proteins on cancer cells.

The benefits are that they may prevent the cancer from getting worse, slow its speed, or even reduce the size of tumors. However, there are some risks. These drugs may lead to side effects, infusion reactions, or autoimmune reactions.

CTLA-4 Inhibitors

CTLA-4 inhibitors are another type of IV drug that work similarly to PD-1/PD-L1 inhibitors except they target CTLA-4 proteins on T cells. Like PD-1/PD-L1 inhibitors, CTLA-4 inhibitors give the immune system a boost. Another distinction is that CTLA-4 inhibitors are not used as the only intervention. They can be used along with a PD-1 inhibitor, and sometimes chemotherapy as well.

CTLA-4 inhibitors may lead to side effects, infusion reactions, or autoimmune reactions.

Vascular Endothelial Factor Inhibitors

Vascular endothelial factor inhibitors are a type of targeted antibody drug that works by preventing new blood vessels of tumors from growing. Since tumors rely on new blood vessels to grow, this intervention prevents the tumors from growing. However, there are possible side effects of monoclonal antibody drugs.

Cancer Vaccines

Disease prevention is not the only objective of vaccines. Therapeutic vaccines, such as cancer vaccines, are used as a treatment. Cancer vaccines are currently in clinical trials.

These vaccines were created from various compounds, such as cells and proteins, to activate the immune system to fight tumor antigens. They were designed to respond to cells with antigens specific to or associated with tumors. Some cancer vaccines are created to fight cancer proteins that are common among many people, while others are created specifically for one person.

Adoptive T Cell Therapy

Like cancer vaccines, adoptive T cell therapy is currently in clinical trials. This treatment uses the immune cells of the cancer patient. More specifically, a person's T cells are removed and altered so they can recognize and attack cancer cells. Then they are put back in the body to fight the cancer. Plasmapheresis is the name of the process of filtering the blood and remove the T cells.

Common Immunotherapy Drugs for Lung Cancer

Rybrevant (Amivantamab)

Rybrevant is a bispecific antibody drug, Bispecific antibodies target two separate antigens at the same time (or two different epitopes on the same antigen). Since many complex diseases such as lung cancer are driven by more than one factor, targeting two antigens can be a more effective form of treatment.

Rybrevant works by targeting epidermal growth factor receptors, or EGFR, and MET receptors of tumor cells.

This drug is used when the patient meets all of the following conditions:

• Is an adult with NSCLC
• Has cancer that has spread beyond the lungs or that cannot be surgically removed
• Has a certain abnormal EGFR
• Has been treated with a chemotherapy containing platinum and the condition got worse during or after that treatment
  

Tecentriq (Atezolizumab)

Tecentriq is a checkpoint inhibitor. It works by targeting the PD-L1 protein present on the surface of cancer cells, which signals to the immune system to attack the cancer cells. This drug is used for advanced NSCLC that has spread and does not have an abnormal EGFR or ALK gene. It can also be used for SCLC (small cell lung cancer). It can be used as a first-line treatment and is sometimes used with chemotherapy.

Avastin (Bevacizumab)

Avastin is a monoclonal antibody drug. It works by targeting the VEGF/VEGFR pathway. This prevents blood vessels of tumors from growing.

The drug is used as a first-line treatment of NSCLS when it cannot be surgically removed, is locally advanced, and is either recurring or has spread.

Libtayo (Cemiplimab)

Libtayo is a checkpoint inhibitor. It works by targeting the PD-1 proteins present on the surface of immune cells. This signals to the immune system to attack the cancer cells.

This drug is used for advanced NSCLC. It can be used as a first-line treatment.

Imfinzi (Durvalumab)

Imfinzi is a checkpoint inhibitor. It works by targeting the PD-L1 protein present on the surface of cancer cells. It signals to the immune system to attack the cancer cells.

This drug is used after chemoradiotherapy (treatment that combines chemotherapy with radiation therapy) for NSCLC that cannot be surgically removed. It can also be used along with etoposide and platinum-based chemotherapy to treat extensive-stage SCLC.

Yervoy (Ipilimumab)

Yervoy is a checkpoint inhibitor. It works by targeting the CTLA-4 pathway and giving the immune system a boost to fight the cancer cells.

This drug is used with Opdivo (nivolumab) for advanced NSCLC that has either spread or grown. It also requires that the tumor does not have an abnormal EGFR or ALK gene. It can be used as a first-line treatment and is sometimes used with chemotherapy. This drug can also be used to treat mesothelioma that cannot be surgically removed.

Portrazza (Necitumumab)

Portrazza is a monoclonal antibody drug. It works by targeting the EGFR pathway and preventing the tumor from growing. This drug is used with squamous NSCLC that has spread. It can be used as a first-line treatment.

Opdivo (Nivolumab)

Opdivo is a checkpoint inhibitor. It works by targeting the PD-1 protein present on the surface of immune cells. This signals to the immune system to attack the cancer cells.

This drug is used with Yervoy (ipilimumab) for advanced NSCLC that has either spread or grown. It also requires that the tumor not have an abnormal EGFR or ALK gene. This drug can also be used to treat mesothelioma that cannot be surgically removed.

Keytruda (Pembrolizumab)

Keytruda is a checkpoint inhibitor. It works by targeting the PD-1 protein present on the surface of immune cells. This signals to the immune system to attack the cancer cells. The drug is used for NSCLC. It can be used as a first-line treatment and is sometimes used with chemotherapy.

Cyramza (Ramucirumab)

Cyramza is a monoclonal antibody drug. It works by targeting the VEGF/VEGFR2 pathway. This prevents blood vessels of tumors from growing.

This drug is used with NSCLC that has spread. It can be used as a first-line treatment.

Who Is a Candidate for Lung Cancer Immunotherapy?

Immunotherapy eligibility depends on the drug. Generally, it is reserved for more advanced cases of lung cancer, stage 3 or stage 4 NSCLC or SCLC. This means the cancer has spread, cannot be surgically removed, or has come back. Testing is done to determine if a patient is a good candidate and which drug may be best.

Biomarker testing, also known as molecular or genomic testing of the tumor, is a way of checking for DNA changes such as mutations. This testing looks for things like EGFR mutation, ALK gene rearrangement, and PD-L1 protein. The results of this testing can help guide treatment options along with other health considerations such as risk factors.

Since immunotherapy drugs activate the immune system and increase the risk of autoimmune reactions, immunotherapy may not be a good option for those with autoimmune diseases such as multiple sclerosis, Crohn's disease, rheumatoid arthritis, or lupus.

Summary

Immunotherapy for lung cancer is a type of drug that uses a person's own immune system to fight the cancer. Common immunotherapy drugs for lung cancer are checkpoint inhibitors, but there are also monoclonal antibodies, cancer vaccines, and adoptive T cell therapies. Patient eligibility and the specific drug to use depends on the patient and their cancer, which can be determined using the help of biomarker testing.

A Word From Verywell

Being diagnosed with lung cancer, especially advanced lung cancer, can be stressful, emotional, and overwhelming. Your healthcare team is available to support you by guiding your decisions as you navigate the available treatments available.

Talk to your doctor if you think immunotherapy may be right for you, or if you have any questions about testing, eligibility, or treatment options.