Immunotherapy for Lung Cancer Patients

Posted on: November 2, 2015

Gigi Chen, MD

By Gigi Chen, MD

For patients with advanced or metastatic lung cancer, the treatment options have traditionally been chemotherapy.  First line treatment usually included a platinum containing chemotherapy.  If cancer progressed after that, then the effectiveness of additional chemotherapy was limited.  Now with immunotherapy, we have new and improved treatment options.

The goal of immunotherapy is to stimulate the immune system so it recognizes the abnormal components found in lung cancer cells by mounting an immune response that destroys or blocks the growth of the cancer.

T-cell is a type of immune cell that can recognize and kill cancer cells.  However, tumor cells can produce a protein called PDL-1, which binds to PD-1 on our T-cells.  This is one of the most common interactions that allow cancer cells to evade our immune system. By blocking the PD-1/PDL-1 interaction, we are able to outsmart the tumor cell and activate of our immune system to destroy cancer.

There have been two immunotherapy drugs recently approved for lung cancer treatments. In March of 2015, the FDA approved Nivolumab (Opdivo) to treat patients with advanced squamous lung cancer whose disease progressed during or after platinum-based first line chemotherapy. More recent FDA approval expands the use of Nivolumab to also treat patients with non-squamous type of lung cancer.  Pembrolizumab (Keytruda) was also approved recently for advanced non-small cell lung cancer patients who have progressed despite receiving platinum-containing chemotherapy or agents targeting EGFR or ALK tumor mutations, and whose tumors are positive for PD-L1 expression.

In the clinical trials comparing Opdivo to docetaxel chemotherapy both in squamous cell cancer and nonsquamous cell cancer, Opdivo was found to improve overall survival compared to docetaxel.  In the non-squamous lung cancer trial which had 582 participants, those treated with Opdivo lived an average of 12.2 months compared to 9.4 months in those treated with docetaxel. Additionally, 19 percent of those treated with Opdivo experienced a complete or partial shrinkage of their tumors, an effect that lasted an average of 17 months, compared to 12 percent among those taking docetaxel, which lasted an average of six months.  In another study, Keytruda was found to improve survival for patients compared to docetaxel chemotherapy in patients with tumors positive for PD-L1 expression.  We are still learning about how best to use biomarkers such as PDL-1 expression to select patients who can benefit from these immunotherapy drugs.

Common side effects included fatigue, decreased appetite, musculoskeletal pain, cough and constipation.  These drugs, due to their impact on the immune system, also cause adverse effects in the lungs, colon, and hormone-producing glands.

Immunotherapy offers an exciting new treatment option for our patients with advanced lung cancer.  In the recent few years, we have made many advances in understanding the biology of lung cancer; allowing us to personalize treatments for individual patients.   

Gigi Chen, MD is a Medical Oncologist and Hematologist with Diablo Valley Oncology.  She has extensive experience in treating lung and gynecologic cancers and sees patients in Pleasant Hill, Rossmoor and San Ramon.

Shine a Light on Lung Cancer – Join Dr. Chen and other medical experts on November 19, 2015 from 6:30-8:30 at the Walnut Creek Library, Oak Room. Panel discussion with Q&A. For more information or to register for the program, please call 925-677-5041.

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