Appledore Medical Group - April 29, 2018

By Yoko Fukuda, MD, Medical Oncologist at Portsmouth Hematology & Oncology

Worldwide, lung cancer causes over 1.69 million deaths each year.1 Recent advancements in cancer treatment, particularly in patients with a certain type of lung cancer, show promising results using a combination of traditional chemotherapy and modern immunotherapy. In some cases, survival rates almost doubled.

What is immunotherapy?

The immune system consists of a complex network of cells and organs. The key cells involved in the immune system are white blood cells that signal, identify, and attack infectious invaders. There are several types of white blood cells, each with their own function.

Immunotherapy is a type of biologic therapy that uses the body's own immune system to fight cancer, lessen the side effects of other treatments, and help heal healthy tissue after treatment. It is a scientific attempt to repair, stimulate, or enhance the immune system so that it can identify and fight cancer cells more effectively. Immunotherapies like Nivolumab and Pembrolizumab may be used alone or in combination with chemotherapy or other medications.

How Does Immunotherapy Work?

Biologic therapies repair, stimulate, or enhance the body’s response to cancer. Biologic therapies can:
  • Eliminate, regulate, or suppress conditions that allow uncontrolled cell growth
  • Enhance the immune system to fight the uncontrolled growth of cancer cells
  • Make cancer cells more vulnerable to destruction by the immune system
  • Change the growth patterns of cancer cells so that they are more like normal cells, and less likely to spread
  • Block or reverse the process that changes a normal or precancerous cell into a cancerous cell
  • Enhance the body's ability to repair normal cells that get damaged by other forms of cancer treatment, like chemo- or radiation therapy
  • Prevent a cancer cell from spreading to other parts of the body

Biologic therapies are most commonly used either to treat cancer that does not or has not responded to other forms of treatment. They also can be used to treat tumors that may respond to the body’s own immune defenses.

Does immunotherapy work for everyone?

Immunotherapy is a relatively new medical advancement, so research is just beginning to show the pros and cons of using it to treat various conditions, including cancer. Researchers are working to better understand how to predict the outcome of using immunotherapy on people who exhibit different characteristics of a disease. For example, they have demonstrated success in using immunotherapy to help treat some forms of lung cancer, but not others.

Following a physical examination and other testing, like blood tests, scans, and/ or biopsies, a physician can help determine the best course of treatment. Options, including immunotherapy, typically depend on the type of cancer, and the composition and size and location of the tumor.

What benefits does immunotherapy show in patients with non-small cell lung cancer?

Research recently published in The New England Journal of Medicine2 showed significant benefit in patients with the non-squamous form of non-small cell lung cancer, which is diagnosed in about 150,0003 cases in the United States every year. According to Dr. Leena Gandhi, lead investigator of the study and director of the thoracic medical oncology program at Perlmutter Cancer Center at NYU Langone Health, combining traditional chemotherapy with the immunotherapy drug pembrolizumab was “superior in terms of response -- keeping people alive without progression of their cancer -- and improving the overall survival of patients with metastatic lung cancer compared to chemotherapy alone. And the differences were not small."

In fact, patients who received both chemotherapy and immunotherapy early in their treatment reduced their risk of death or progression of their cancer by 48% when compared to patients who only received chemotherapy. Median survival is measured by how long 50% of patients with a certain condition will live. For non-squamous, non-small cell lung cancer patients, median survival with chemotherapy alone is 11 to 12 months, but the median survival among patients in the study who received a combination of immunotherapy and chemotherapy has not yet been reached after more than 21 months.

What are the side effects of combined chemotherapy and immunotherapy?

The most common side effects, which were sometimes severe, of combining chemotherapy and immunotherapy were:

  • Nausea
  • Anemia
  • Fatigue
  • Acute kidney injury (higher at 5.2% than in 0.5% of patients just receiving chemotherapy)

Other side effects may include:

  • Joint pain
  • Diarrhea
  • Rash
  • Itching
  • Poor wound healing
  • Loss of appetite

How is immunotherapy administered?4

The type of immunotherapy given depends on the type of cancer, which, in turn, determines the way it is administered. Methods include:

  • Intravenous (IV): given directly into a vein.
  • Oral: pills or capsules that you swallow.
  • Topical: a cream that is rubbed into the skin (typically used for very early stages of skin cancer)
  • Intravesical: administered directly into the bladder

To learn more about immunotherapy and other treatment options for different types of cancer, visit the National Cancer Institutes Cancer Treatment Summaries.

How often is immunotherapy treatment given?4

How often immunotherapy treatment is given depends on:

  • The type of cancer and how advanced it is
  • The type of immunotherapy
  • How the body reacts to initial immunotherapy treatment

Some immunotherapy treatments are administered daily, weekly, or monthly. Some are given in cycles with treatment occurring, followed by a period of rest, which allows the body to “recover, respond to the immunotherapy, and build new healthy cells.”

1 World Health Organization (WHO)
2 New England Journal of Medicine (NEJM) “Pembrolizumab plus Chemotherapy in Metastatic Non–Small-Cell Lung Cancer”. Leena Gandhi, M.D., Ph.D., Delvys Rodríguez-Abreu, M.D., Shirish Gadgeel, M.B., B.S., Emilio Esteban, M.D., Enriqueta Felip, M.D., Ph.D., Flávia De Angelis, M.D., Manuel Domine, M.D., Ph.D., Philip Clingan, M.B., B.S., Maximilian J. Hochmair, Ph.D., Steven F. Powell, M.D., Susanna Y.-S. Cheng, M.D., Helge G. Bischoff, M.D., et al. (April 16, 2018).
3 CNN - “Treatment combo nearly doubles survival time in lung cancer patients, study finds.”
4 National Institutes of Health (NIH) National Cancer Institute