Emerging Treatments in Lung Cancer

For decades, the primary approach to lung cancer treatment focused on chemotherapy, especially in patients with advanced tumor metastases. Yet, as the various types of non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) are better understood as diverse diseases, curative treatment options are increasingly tailored to the individual patient’s tumors.

Today, emerging treatments and medication for lung cancer include targeted therapies (like veliparib and anlotinib), immunotherapies (like durvalumab and nivolumab), and clinical trials that combine these and other forms of therapy to create individualized care.

The more recent understanding of lung cancer has discarded the one-size-fits-all cancer treatment approach that has been the standard of care since 1980: first-line chemotherapy combined with a platinum-based drug. Research in recognizing the signs of cancer earlier as well as early diagnoses have likewise expanded the availability and efficacy of treatment options. As such, positive results from the use of emerging treatments depends greatly on the accurate diagnosis of the specific cell types found in tumors.

A majority of targeted therapies and immunotherapies rely on certain biomarkers found on cancerous cells to be effective. Subsequently, the following emerging treatments may not deliver an immune response and kill tumors in all patients. For example, only 20 percent of patients with SCLC responded to treatment with the immunotherapy drugs ipilimumab and nivolumab.

Targeted Therapy

While local treatments work only on a specified area (such as lobectomy of the lung). Targeted therapy is a form of systemic therapy, meaning its effects cover the entire body. Moreover, unlike other systemic treatments such as chemotherapy – which attempts to kill all cells it touches – targeted therapy focuses its attacks by looking for particular genetic mutations specific to cancer cells.

By targeting these differences, these treatments typically prevent tumors from growing and spreading. Often, this is accomplished by cutting off blood supply to the tumor using medication from the class of angiogenesis (meaning, creation of blood vessels) inhibitors. Without new blood, the cancerous cells eventually shrink and die.

Generally, targeting cancer-killing activities solely on the affected cells results in fewer side effects of treatment compared to those of chemotherapy, radiation, and surgery. Targeted therapies’ high rates of tolerability and effectiveness (in certain patients) have led to the medications being granted Breakthrough Therapy or Fast Track status by the U.S. Food and Drug Administration (FDA).

Some side effects of commonly used targeted therapy medications include:

  • Bone marrow damage
  • Diarrhea
  • Liver damage
  • Skin rash

Examples of recently studied genetic mutations for targeted therapies include:

  • EGFR
  • EML4-ALK
  • KRAS
  • ROS1
  • BRAF
  • HER2
  • MET
  • PIK3CA
  • RET
  • MEK
  • NTRK

Approximately 15 percent of patients with lung cancer are EGFR-positive and can receive EGFR inhibitor medicines. Other mutations are typically rarer among the general population.

Immunotherapy

Previously, oncologists and researchers didn’t believe the body’s immune system could be used to fight cancer due to the ability of affected cells to essentially “hide in plain sight” among healthy cells. Today, however, the field of immunotherapy proves the efficacy in using immunological responses (such as T cells and white blood cells) to fight lung cancer. These types of drugs work by allowing the immune system to recognize cancer cells and enabling them to attack. Immunotherapy medications used to treat NSCLC and SCLC usually fall into one of the following categories:

  • Adoptive T-cell transfer
  • Gut microbiome therapy
  • Immune checkpoint inhibitors (ICIs)
  • Monoclonal antibodies
  • Therapeutic vaccines

Commonly, immunotherapy medications end in either “-ib” (i.e., small molecule drugs that penetrate the cells to work) or “-ab” (i.e., monoclonal antibodies that focus attacks based on markers on cells’ surface).

This is an infograph representing an immunotherapy treatment approval by the FDA.
Recently approved in 2018, nivolumab (Opdivo®) was the first new treatment for SCLC approved by the FDA in two decades and was the first immunotherapy medication of any kind to receive approval. Current clinical trials combine the two most common immunotherapies for patients who test high for levels of certain biomarkers (such as the PD-L1 protein): ICIs (such as nivolumab) and monoclonal antibodies (atezolizumab, durvalumab, ipilimumab, pembrolizumab).

Side effects of immunotherapy are caused by the inflammation brought on by the body’s immunological response. While side effects are generally mild, inflammation can occur anywhere in the body. Additionally, if the immune system becomes overloaded, a severe autoimmune response requires immediate medical attention.

Common immunotherapy side effects include:

  • Fatigue
  • Loss of appetite
  • Muscle or joint ache
  • Nausea
  • Vomiting
This is an icon representing a Lung Cancer Vaccine.

Lung Cancer Vaccines

Another growing type of immunotherapy, cancer vaccines decrease the risk of lung cancer and attempt to prevent it from recurring. Similar to vaccines for viruses like the seasonal flu, lung cancer vaccines initiate a response from the immune system to find and attack cancer cells.

Recently, clinical trials testing the efficacy of the cancer vaccine CIMAvax-EGF (or, the “Cuban Vaccine”) combined with immunotherapy ICI nivolumab produced a response rate in 51 percent of patients with NSCLC. Reported side effects include:

  • Diarrhea
  • Fever
  • Irritation at injection site
  • Muscle aches
  • Nausea
  • Vomiting

Clinical Trials

For lung cancer patients today whose tumors cannot be cured or maintained with current treatments, clinical trials often offer the best hope of remission. Emerging treatments are continuously discovered and evaluated against the effectiveness of popular therapy methods. Too, old and new methods may be combined to produce an entirely new care program.

Clinical trials are always open, and many are accepting patients for each type and stage of lung cancer. As long as a patient meets the criteria for joining a specific clinical trial, they may be accepted and gain access to state-of-the-art medical care. Current and ongoing clinical trials can be found with the National Cancer Institute as well as through a doctor and/or hospital.

Emerging treatments combined with certain diet and exercise changes may effectively improve a patient’s prognosis. Talk to your doctor about the options available to your specific case.