Lung Cancer and Immunotherapy
Immunotherapy for lung cancer, first-line therapy or in combination with other conventional treatments, significantly improve outcomes for patients with lung cancer.
The most common cancer worldwide,
Lung cancer impacts approximately 2.1 million people and causes an estimated 1.7 million deaths annually. It is considered to be the leading cause of cancer-related deaths for both men and women.
Lung cancer and its two major types are enlisted below:
- Small cell lung cancer (SCLC) – 10-15% of all known lung cancer cases
- Non-small cell lung cancer (NSCLC) – 85-90% of all known lung cancers cases
- Adenocarcinoma of lung arises from mucus secreting cells in the (40% of lung cancers).
- Squamous cell (epidermoid) carcinoma arises from the flat squamous cells lining inside of the airways of the lung (25-30% of lung cancers)
- Large cell (undifferentiated) carcinoma arises from the epithelial cells lining of outer regions of the lung (10-15% of lung cancers).
- Mesothelioma – thin layer of tissue that covers many the lungs gives rise to this form of lung cancer
Varied lung cancer cases are symptomatic and diagnosed, at advanced to late-stage (at stage 3b/4 or higher).
And at these stages, surgery, chemotherapy, and radiation are only minimal to negligible effects.
New treatments for patients facing an advanced lung cancer diagnosis include immune-based cancer treatment arm called biologic therapy or Immunotherapy.
Immunotherapy in advanced disease is helping to improve chances of Quality of life (QOL) for patients with lung cancer and increased survival rate.
Immunotherapy for Lung Cancer
Lung Cancer Treatment Options until recently were encircled around conventional treatment options like surgery, chemotherapy, and radiation.
Majority of the cases diagnosed with advanced disease (stage 3b/4), result with incomplete cures in lieu of conventional treatment options, though they may significantly improve survival and provide symptom relief, but not immunotherapy has changed the outlook for lung cancer patients
It was in 2015 when FDA approved the first immunotherapy to treat a subset of lung cancer patients.- a revolutionary era
Immunotherapy is a class of treatment that helps a particular individual’s own immune system to eliminate or control cancer. For more details read How does immunotherapy work for cancer treatment?
The recent clinical trials published and ongoing are able to treat patients with immunotherapy.
This is well achievable as the first line of therapy i.e. either alone or in combination with other treatments.
And this has been demonstrated with the significant association of patient QOL improvement and increased survival rate.
FDA approval of several other immunotherapy options for more lung cancer patients, including approvals to treat patients with immunotherapy as a first-line therapy instead of conventional treatments is a major kick in this changing outlook
Targeted Antibodies
- Amivantamab (Rybrevant™): a bispecific antibody ttargets EGFR and MET receptors on tumor cells;
Approved for subsets of patients with non–small cell lung cancer (NSCLC) as first-line therapy as well
- Bevacizumab (Avastin®): a monoclonal antibody targets the VEGF/VEGFR pathway
Approved for subsets of patients with advanced non-small-cell lung cancer (NSCLC), again included as a first-line therapy
- Necitumumab (Portrazza®): a monoclonal antibody targets the EGFR pathway
Approved for subsets of patients with advanced non-small-cell lung cancer (NSCLC) as a first-line therapy
- Ramucirumab (Cyramza®): a monoclonal antibody that targets the VEGF/VEGFR2 pathway
Approved for subsets of patients with non-small cell lung cancer (NSCLC), as a first-line therapy
Immunomodulators
- Atezolizumab (Tecentriq®): checkpoint inhibitor target the PD-1/PD-L1 pathway
Approved for advanced non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) cases including as first-line therapy and also in combination with chemotherapy.
- Cemiplimab (Libtayo®): a checkpoint inhibitor targets the PD-1/PD-L1 pathway
Approved for a subset of patients with advanced non–small cell lung cancer (NSCLC)
- Dostarlimab (Jemperli): a checkpoint inhibitor targets the PD-1/PD-L1 pathway
Approved advanced lung cancer cases with DNA mismatch repair deficiency (dMMR)
- Durvalumab (Imfinzi®): a checkpoint inhibitor targets the PD-1/PD-L1 pathway
Approved for patients with stage III non-small-cell lung cancer (NSCLC) after the completion of chemoradiation,
Also recommended in patients with advanced small-cell lung cancer (SCLC) in combination with chemotherapy
- Ipilimumab (Yervoy®): a checkpoint inhibitor targets the CTLA-4 pathway
Approved, in combination with nivolumab, as a first-line treatment, in advanced non-small cell lung cancer (NSCLC) and mesothelioma
- Nivolumab (Opdivo®): a checkpoint inhibitor that targets the PD-1/PD-L1 pathway
Approved for patients with advanced non-small-cell lung cancer (NSCLC) and mesothelioma in combination with ipilimumab, with or without chemotherapy
- Pembrolizumab (Keytruda®): a checkpoint inhibitor that targets the PD-1/PD-L1 pathway
Approved for patients with advanced non-small-cell lung cancer (NSCLC), including as a first-line therapy
These immunotherapy approvals are landmark events for the treatment of lung cancer that has surely changed the lung cancer patient outlook.
As with these immunotherapies, many advanced-stage lung cancer patients presents with long-lasting remissions and longer survival rates.
Dr. Sajjan Rajpurohit is a renowned and esteemed international Cancer Specialist Doctor based In Delhi NCR with 17plus years of experience and has treated more than 94000 cancer patients- still serving humanity with pride.
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