Lung Cancer: Immunotherapy

Immunotherapy is a type of cancer treatment that boosts your body’s immune system to help it recognize and attack cancer cells. It uses substances that are either made in the body or in a lab. These substances either boost the immune system overall or to help it better target cancer cells.

Immunotherapy can be used for people with advanced non-small cell lung cancer (NSCLC).

Immunotherapy can be used to treat advanced small cell lung cancer (SCLC), too. 

These medicines can shrink some tumors or slow tumor growth.

The immunotherapy medicines used to treat lung cancer are called immune checkpoint inhibitors . The body uses certain checkpoint proteins on cells to help keep the immune system from attacking normal, healthy cells. Cancer cells sometimes use these checkpoints to keep from being attacked by the immune system. Checkpoint inhibitors block the checkpoints to help the immune system recognize and attack the cancer cells. 

The checkpoint inhibitors used to treat lung cancer target PD-1, PD-L1, or CTLA-4. These are proteins found on certain immune cells and cancer cells. Before immunotherapy is started, lab tests are done to see if your cancer cells are using checkpoints, and, if so, which one. The immunotherapy medicine used must work on that checkpoint.

Common immunotherapy medicines used to treat lung cancer include:

• Pembrolizumab

• Nivolumab

• Atezolizumab

• Durvalumab

• Ipilimumab

• Cemiplimab

• Tremelimumab

Before treatment starts, you'll meet with a medical oncologist. This is a healthcare provider with special training to treat cancer with medicines. This provider will discuss your treatment choices with you and explain what you might expect. 

The immunotherapy medicines used to treat lung cancer are given as an infusion into a vein (IV). They are usually given once every 2, 3, 4, or 6 weeks. This is usually done in an outpatient setting. This means you get it at a hospital, clinic, or healthcare provider's office and go home after treatment.

You'll be watched for reactions during your treatments. Since each of your treatments may last for a while, you may want to take along something that's comforting to you, such as music to listen to. You may also want to bring something to keep you busy, too, like a book or mobile device.

Side effects of immunotherapy tend to be very different from those of other kinds of cancer treatment, such as chemotherapy. In many cases they're less severe. But they can still be serious in some people.

Ask your healthcare provider or nurse for more details about possible side effects. Tell them about any changes or side effects you notice right away. They can suggest things to help you feel better. In most cases, side effects start getting better over time after treatment ends. But some may last a longer time.

Some of the more common side effects of immunotherapy can include:

• Feeling tired (fatigue)

• Cough

• Nausea

• Skin itching or rash

• Loss of appetite

• Bowel changes (diarrhea or constipation)

• Joint pain

Less often, these medicines can cause more serious side effects. These are often because immunotherapy lets the immune system attack some normal cells in the body. This can lead to serious or even life-threatening problems in the lungs, kidneys, liver, intestines, hormone-making glands, or other organs.

Some people have an allergic reaction while getting treatment. This might include:

• Fever
• Chills
• Flushing
• Dizziness
• Wheezing
• Trouble breathing
• Rash
• Itchy skin

You'll be watched closely during treatment. It's important to let your nurse know about any changes you notice during the infusion. 

It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause.

Talk with your healthcare providers about what signs to look for and when to call them. Make sure you know what number to call with questions. Is there a different number for evenings, holidays, and weekends?

It may be helpful to keep a diary of your side effects. A written list can make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.