If you have metastatic non-small cell lung cancer (NSCLC), your doctor may consider a new type of treatment for you called immunotherapy. Doctors use these medicines to boost your immune system so it will recognize and kill cancer cells.
Scientists are researching four main types of immunotherapies for lung cancer: checkpoint inhibitors, monoclonal antibodies, therapeutic vaccines, and adoptive cell therapy. They’re also looking to see if combinations of these drugs will help.
Three immunotherapy drugs have been approved for use in metastatic non-small cell lung cancer. All are checkpoint inhibitors:
Immune checkpoints are meant to hold back your body’s natural defenses so they don’t damage healthy tissues. All three drugs work on the PD-1 checkpoint, either directly or indirectly. This is a checkpoint cancer cells use to stop your body from killing the tumor. By blocking it, your immune system is better able to spot and kill cancer cells.
But immunotherapy doesn’t work for all types of metastatic NSCLC, and it’s not for all people with the disease. How do you know if it’s right for you?
Immunotherapy as First Treatment
Scientists know that lung tumors with high levels of the protein PD-L1 are more likely to respond to a pembrolizumab than to the other approved treatments. About a third of people with late-stage NSCLC have very high levels of PD-L1.
If you have metastatic lung cancer with PD-L1 in more than half the cells, you can use pembrolizumab right away. You won’t have to try chemotherapy or other drugs first.
If you have a change in your genes (known as a mutation) called an epidermal growth factor receptor (EGFR) or an aplastic lymphoma kinase (ALK), you shouldn’t get immunotherapy as your first treatment. Another type of treatment called targeted therapy will shrink the tumor better.
Immunotherapy as Second Treatment
If you have late-stage lung cancer that hasn’t responded to platinum-based chemotherapy or that has started to come back after chemo or other drug treatments, your doctor may suggest you try a checkpoint inhibitor. Both nivolumab and atezolizumab are approved for anyone with advanced NSCLC who’s already tried chemotherapy, regardless of the levels of PD-L1 in the tumors. Even if your tumor biopsy shows no PD-L1, immunotherapy may still work for you.
Checkpoint inhibitors have worked well for some people with metastatic cancer. So far they’ve helped about 20% of people with NSCLC, Research is underway to figure out who will benefit and who won’t.
Who Shouldn’t Get This Treatment?
If you have an autoimmune disease -- like lupus, thyroiditis, Crohn’s disease, or rheumatoid arthritis -- immunotherapy may not be safe for you. Your doctor will also want to make sure any active or chronic infections are under control before starting this type of treatment.