For the treatment of lung cancer, immunotherapy medications boost the patient's immune system to fight cancer, but may not be effective for everyone. Depending on the genes present in the patient's tumors, immunotherapy drugs may provide long-term relief.
What Immunotherapy Medications Are
Used to Treat Lung Cancer?
Just as every individual is unique, each person’s case of lung cancer is different. Not all lung tumors respond the same way to traditional treatments (such as chemo). Some people require alternate forms of cytotoxic (i.e., cancer-killing) therapy. Immunotherapy is an emerging treatment that can be individualized for each patient’s type of cancer.
Immunotherapy is a form of cancer treatment that boosts the body’s immune system in order to identify and kill cancerous cells. Other types of immunotherapy drugs use various aspects of the immune system to shrink, slow, or stop the growth of tumors, or prevent them from spreading to other areas of the body.
Immune therapy drugs may be given on their own, in combination with each other, or in conjunction with other types of treatment.
Types of Immunotherapy Medication
Most lung cancers are diagnosed after it has advanced to stage III or IV. Consequently, most treatments for lung cancer focus on reducing the effects of painful complications of growing tumors. Late-stage cancers are unlikely to be cured but immunotherapy medications can reduce the size of tumors, stop them from growing or spreading, and even kill certain masses. However, the cell types present in a patient’s lung cancer greatly determine the efficacy of various immunotherapy drugs. Not all patients will respond to treatment.
Each category of immunotherapy treatment works through different pathways to fight cancer. Some immunotherapy medications boost the immune system as a whole to protect the body. Other drugs are created for each patient in a laboratory using cancer cells found in the lungs. In a lab, doctors are able to design medications capable of recognizing healthy cells from cancerous ones and enabling the immune system to attack.
The major types of immunotherapy medications currently approved for use or being studied in clinical trials include:
- Monoclonal antibodies (including immune checkpoint inhibitors)
- Oncolytic virus therapies
- T-cell therapy
For a complete and up-to-date list of immunotherapy medications approved to treat non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), visit the National Cancer Institute.
Monoclonal Antibody Medications
When foreign invaders are detected in the body (such as viruses and bacteria), the body releases antibodies. Antibodies attack infections by attaching to the foreign antigens, initiating an immune response. Monoclonal antibodies are lab-made and can be used to attack lung cancer in different ways. Some targeted therapies are designed to fight specific cancer cell types; others make the area too harsh for cancerous cells to survive, grow, and spread.
So far, few monoclonal antibody medications have been approved by the FDA (i.e., the Food and Drug Organization, responsible for approving new medications in the U.S.) to treat lung cancer. Only two monoclonal antibody drugs, bevacizumab (Avastin®) and ramucirumab (Cyramza®) are approved for treatment. These drugs choke blood vessels that supply nutrients to cancerous tumors. Others are also undergoing investigation in clinical trials across the country.
Immune Checkpoint Inhibitor Medications
Immune checkpoint inhibitors, also known as immunomodulators, are another type of monoclonal antibody that has revolutionized the outlook of certain cancers in patients who had previously been unresponsive to treatment. Immunomodulator drugs work by allowing the immune system to distinguish between healthy cells and precancerous or cancerous ones.
Normally, cancer cells are born from previously healthy, yet mutated lung cells. Immune checkpoint inhibitor medication targets specific points on cancer cells that hide them from the immune system and disables them. PD-1 and PD-L1 are the most common inhibitors targeted by immunomodulator medications.
Most immunotherapy medications are not available for broad, public use, and are still undergoing rigorous study in clinical trials. The four treatment medications below are the first immune checkpoint inhibitor drugs approved by the FDA for the treatment of NSCLC. They include:
- Atezolizumab (Tecentriq®) – Used to treat advanced NSCLCs (that are not squamous cell) and advanced SCLCs after other treatments stopped working. Usually, the drug is prescribed at the same time as chemo treatment drugs carboplatin, etoposide, or paclitaxel. Bevacizumab may be given in combination with this drug.
- Durvalumab (Imfinzi™) – A type of immunomodulator approved to treat NSCLC that cannot be treated with surgery but has responded to chemotherapy and radiation.
- Nivolumab (Opdivo®) – A PD-L1 inhibitor primarily approved to treat NSCLCs that have not responded to other treatments (such as chemotherapy and EFGR or ALK targeted therapies). Has also been approved to treat melanoma and bladder, head and neck, and kidney cancer.
- Pembrozulimab (Keytruda®) – For NSCLC patients, this drug can be used with or after chemotherapy for patients whose tumors have certain genetic markers.
Immunomodulator medications targeting CTLA-4 inhibitors currently being studied for the treatment of lung cancers include:
- Ipilimumab (Yervoy®)
Oncolytic Virus Therapy Medications
Oncolytic virus therapy is a new type of cancer treatment that uses oncolytic viruses (i.e., viruses that prefer to infect and kill cancer cells) to kill tumors. First, the viruses have been altered in a lab to target cancer cells instead of healthy ones. Next, the modified viruses are injected directly into the tumor. Inside the cancerous tumor, the virus replicates itself uncontrollably until the tumor bursts. The dying cell triggers the immune system to attack similar types of cancer cells throughout the body.
The FDA approved talimogene laherparepvec (Imlygic® or T-VEC) as a second-option treatment for advanced-stage melanomas where surgery is not an option. The T-VEC virus is an altered herpes simplex virus (the infection responsible for cold sores) and can be injected into melanoma cells until none remain.
T-cell Therapy Medications
T-cell therapy is a form of immunotherapy that removes the patient’s T-cells (i.e., types of white blood cells that fight infection), modifies them in a lab, and gives them back to the patient to kill cancerous cells around the body. T-cell therapy is sometimes called CAR (chimeric antigen receptor) T-cell or ACT (adoptive cell transfer) therapy. These therapies have worked well in treating blood cancers and are currently being studied for their efficacy against lung cancers.
Tisagenlecleucel (Kymriah®) is approved to treat certain leukemia cells while axicabtagene ciloleucel (Yescarta®) can be used to treat certain types of non-Hodgkin lymphoma. Other T-cell medications being studied include:
- Imiquimod (Zyclara®)
- Lenalidomide (Revlimid®)
- Pomalidomide (Pomalyst®)
- Thalidomide (Thalomid®)
Typically, vaccines work by “teaching” the body’s immune system how to fight specific infections. Cancer vaccines operate in a similar way, using a patient’s cancer antigens to teach T-cells how to fight off cancer’s cell types, should they ever return.
Clinical trials are the only available provider of cancer vaccines, today. Interested patients should speak with their health care provider about finding ongoing clinical trials. Or, visit ClinicalTrials.gov to search the database provided by the National Institutes of Health, U.S. National Library of Medicine.