Immunotherapy For Late-Stage Lung Cancer
- Immunotherapy now extends to more patients with stage three non-small cell lung cancer (NSCLC), offering new treatment possibilities.
- Targeting cancer-specific proteins like PD-L1, immunotherapy boosts the immune system’s ability to combat lung cancer cells.
- Keytruda (pembrolizumab) received FDA approval as a first-line treatment for lung cancers that are inoperable, enhancing immunotherapy options.
- Eligibility for Keytruda treatment requires the absence of ALK or EGFR genomic aberrations, focusing on lung cancers with specific genetic markers.
- In advanced lung cancer stages, checkpoint inhibitors such as Keytruda, Opdivo, and Tecentriq are promising, used alone or with other therapies.
There is some encouraging news for people with later stage lung cancer. Immunotherapy is now an option for more patients who have just been diagnosed with stage three non-small cell lung cancer (NSCLC), which is the most common form of the disease.
Watch: Dr. Brendan Stiles, thoracic surgeon at Weill Cornell Medicine and NewYork-Presbyterian on expanded use of immunotherapy for lung cancer
What is Immunotherapy
Read MorePD-1 helps cancer cells hide from the immune system. Blocking PD-L1 can allow the immune system to recognize and attack the cancer cells. Patients with high levels of these proteins often see significant benefits from immunotherapy, including extended survival rates. Additionally, immunotherapy generally causes fewer and milder side effects than traditional cancer treatments like chemotherapy. This leads to a better quality of life for patients.
Perhaps most importantly, some patients experience long-term control of their cancer, a major advantage over conventional therapies. Immunotherapy’s targeted action, effectiveness in certain patient groups, and potential for sustained benefits make it a key advancement in combating lung cancer.
Dr. Vamsidhar Velcheti, the director of thoracic oncology at NYU Perlmutter Cancer Center. immunologyImmunotherapy, says that immunotherapy is transforming lung cancer treatment.
“The ways cancer generally escapes the body’s immune system is by protecting itself by producing certain proteins,” he explained. “PD-L1 is one of those proteins that actually helps protect cancer from the body’s immune system. For patients that have high levels of PD-L1, you could potentially use a single-agent immunotherapy with good outcomes. The problem is that these proteins are constantly influx.”
Keep in mind that, while immunotherapy is an exciting area of development in cancer research, it doesn’t work for everyone. The drugs can also come with hefty price tags and major side effects.
To learn more about immunotherapy and its suitability for you, discuss it with your care team.
Immunotherapy, when surgery is not an option
For lung cancer that can’t be surgically removed, the FDA now approves Keytruda (pembrolizumab) as a first-line treatment. This approval is part of a growing trend in using immunotherapy for lung cancer treatment.
Keytruda, an immunotherapy drug, effectively treats certain lung cancers by boosting the immune system’s ability to detect and fight cancer cells. It’s particularly beneficial for advanced lung cancer with specific genetic markers.
To qualify for Keytruda, patients should not have ALK or EGFR genomic aberrations, as mutations in these genes are better treated with other targeted therapies. These mutations involve alterations in the ALK or EGFR genes, which can affect how lung cancer grows and responds to treatments.
Keytruda chemotherapy combo
Before its latest approval, Keytruda was already authorized for treating metastatic NSCLC with PD-L1 expression, particularly after progression post-platinum-containing chemotherapy. This was part of a series of approvals for Keytruda in various cancer treatments, showing its increasing role in immunotherapy for lung cancer.
The Keytruda-chemotherapy combo approval was based on findings from a phase 3 trial called Keynote-671 which showed an improved overall survival rate in people with NSCLC who were treated with this protocol compared to people who were treated with just chemotherapy (15.9 months vs. 11.3 months).
The Keytruda-chemo combo also increased the average person’s survival without progression of the disease from 4.8 months with chemo alone to 6.4 months. The extent of benefit or life extension from immunotherapy may seem modest, but its impact continues to grow.
Related: Understanding How Immunotherapy Works
“With this important approval, more patients will have the opportunity to benefit from immunotherapy,” investigator Dr. Balazs Halmos, of the Montefiore Einstein Center for Cancer Care told SurvivorNet.
The Keytruda-chemo combo has the potential to help tens of thousands of Americans with lung cancer but results are nowhere near guaranteed.
“Lung cancer is not one disease, it’s not the same in everybody,” said thoracic oncologist Dr. Leena Ghandi during a discussion about immunotherapy in general. “Cancer drugs work differently in individuals, and every individual’s cancer is different, by definition.”
Other Immunology therapies
Keytruda is a type of immunology drug known as a checkpoint inhibitor.
Checkpoint inhibitors work by blocking proteins that prevent the immune system from attacking cancer cells. These proteins, known as checkpoints, are normally used by the body to prevent the immune system from overreacting. In cancer treatment, checkpoint inhibitors release these brakes, enabling the immune system to recognize and destroy cancer cells more effectively.
For stage 4 lung cancer, there are two main checkpoint inhibitors, and these are PD-1/PDL-1 and CTLA4 inhibitors.
Besides Keytruda, widely used checkpoint inhibitors include the Opdivo (nivolumab), Tecentriq (atezolizumab), Yervoy (ipilimumab), and Libtayo (cemiplimab-rwlc) and Imfinzi (durvalumab).
Sometimes these drugs are given as monotherapy and others work better coupled with additional treatments like chemotherapy. Your treatment team will decide how these drugs should be given to you based on your unique situation.
However, it is important to understand that these drugs do not work for everyone and can sometimes stop working after some time.
Your doctor will give you all your options regarding the best option for your treatment. In fact, Dr. Raja Flores, chair of the Department of Thoracic Surgery at Mount Sinai Hospital, reiterates the importance of each of these treatments for metastatic lung cancer patients.
“It’s very important to take things step by step. So usually, with stage 4, it’s chemotherapy. And I never take surgery off the table.” he told SurivorNet. “When you have a stage 4 patient, it’s important to make sure that they understand that chemotherapy is something that they have to look at, but it’s not the only option.”
This only confirms that even though a diagnosis of late-stage lung cancer can be overwhelming, it’s not a death sentence. Actually, there are multiple options to treat this disease, and they are all applicable but vary depending on the patient’s medical care and overall health.
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