Immunotherapy is one of several treatment options for non-small cell lung cancer (NSCLC). A type of immunotherapeutic medication called immune checkpoint inhibitors teaches the body’s immune system to recognize and destroy cancer cells. It can have longer-lasting effects than other treatment options for NSCLC and can improve the outlook for people with the disease.

Immunotherapy is a new and emerging treatment option for cancer. Many of the first clinical trials on its effectiveness were initially published in 2015 or later.

Several studies have shown that immunotherapy can enhance overall survival for people with NSCLC. So the Food and Drug Administration (FDA) has approved several immune checkpoint inhibitors to help treat this condition.

This article will describe how doctors use immune checkpoint inhibitors to treat NSCLC. It will compare this treatment with chemotherapy and radiation therapy and explain what a person taking this medication can expect before and during treatment.

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If a person is having immunotherapy, it means they are receiving medications that help their own immune system to find and destroy cancer cells.

The immune system protects the body against certain dangers, such as bacteria and fungi. But it does not always identify cancer cells as a danger. Immunotherapy teaches the body this difference, as well as how to fight these cancer cells. Scientists sometimes achieve this by introducing cells to the body that they have made or modified in a laboratory setting.

Sometimes, cancer cellscontain “messengers” that essentially shut down the immune system. Immunotherapy may also target these messengers, which keeps the immune system working at its best.

Some people visualize cancer cells as putting the “brakes” on immune system cells. Medications, such as immune checkpoint inhibitors that treat NSCLC, work to take the brakes off so the immune system can work better.

Immune checkpoint inhibitors are not effective in all people who have NSCLC. Some people are treatment-resistant, meaning the medications do not seem to help at all. Other people develop acquired treatment resistance. This means the medications work for a while, then stop working. A person should ask their doctor about how well they perceive the medication to be working.

There are several key similarities and differences between immunotherapy and other NSCLC treatments, such as chemotherapy and radiation therapy. These include their:

  • Function: Immunotherapy focuses on the entire immune response, teaching it to react more effectively to the presence of cancer cells. Chemotherapy kills cancercells directly but affects the whole body, too. Radiation therapy works by being directed to specific areas in the body to destroy cancerous cells.
  • Location: Immunotherapy is a systemic treatment for cancer. This means the approach affects the entire body instead of a specific tumor area. Chemotherapy is also systemic. Systemic cancer treatments are different from regional options such as radiation, which doctors aim directly at a specific area of cancer cells.
  • Effectiveness: Taking immunotherapy alone or in combination with other therapies, such as chemotherapy or radiation therapy, can significantly improve outcomes in people with lung cancer. Immunotherapy can provide long-term benefits because instead of attacking the cancer only while the treatment is in a person’s body, it teaches the body to fight the cancer. The body can remember this even once treatment has finished.
  • Side effects: Chemotherapy can attack healthy cells as well as cancerous ones, so a person can experience hair loss and nausea due to cell damage. Side effects from immunotherapy happen when the body overreacts to the treatment, or it receives it in the wrong place. Symptoms can range from mild to life threatening.

A doctor may prescribe immunotherapy treatments in combination with chemotherapy. As well as combining different immune checkpoint inhibitor types, this combination may help a person with NSCLC live longer, according to a 2019 article in the journal Clinical Cancer Research.

For example, a study published in the New England Journal of Medicine compared people with metastatic NSCLC receiving chemotherapy with people who received chemotherapy plus the immunotherapy pembrolizumab. After 12 months, the estimated overall rate of survival for the group who received both medications was 69.2% compared with 49.4% who took only chemotherapy.

Learn about the 10 most common side effects of chemotherapy here.

Doctors prescribe three main types of immune checkpoint inhibitors to treat NSCLC. These are:

  • PD-1 inhibitors: Programmed-death 1 (PD-1) is a protein naturally present in the body. The protein is on the surface of immune system cells known as T cells. These cells work to protect the body from infection and may have cancer-fighting properties. PD-1 inhibitors include the medications pembrolizumab and nivolumab.
  • PD-L1 inhibitors: Programed-death ligand-1 (PD-L1) is another protein type that some cancer cells commonly have. If PD-1 attaches to PD-L1, the PD-1 protein signals the PD-L1 cell to stop killing the cancer cell. PD-L1 inhibitors include the medications atezolizumab and durvalumab.
  • CTLA-4 inhibitors: Cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4) inhibitors boost the immune response by blocking the CTLA-4 proteins that exist on T cells. One example is ipilimumab. It can work alongside nivolumab and does not necessarily require chemotherapy.

Doctors prescribe PD-1 and PD-L1 inhibitors as immunotherapy fighters to enhance a person’s immune system. Doctors call these types immune checkpoint inhibitors. These medications help to ensure the immune system kills cancerous cells.

If a doctor thinks immunotherapy will work, a person will usually take the medications until their cancer progresses or the disease becomes too toxic. If they have an unanticipated side effect, they may also discontinue the medication.

Other types of immunotherapy for NSCLC include immune system modulators and therapeutic vaccines.

Learn more about these different types of immunotherapy for lung cancer here.

A doctor may perform biomarker testing before prescribing immunotherapy. This testing measures the likelihood of response to immunotherapy. Some tumors do not express PD-L1 proteins. When this is the case, prescribing the medications would likely be ineffective. Because these tests are not perfect predictors, some doctors may not use them.

A doctor will describe a person’s overall treatment plan to them. This should include:

  • an explanation of recommended medications
  • their anticipated side effects
  • how they will help to treat a person’s cancer

Learn about possible complications of lung cancer here.

The processes and side effects of immune checkpoint inhibitors for NSCLC will depend on which type of treatment a person receives.

DrugProcessPossible side effects
nivolumab, pembrolizumab, cemiplimab, atezolizumabPeople may require a lab test. Doctors may recommend chemotherapy alongside this treatment.
People will receive these medications intravenously every 2, 3, 4, or 6 weeks.
People may experience tiredness, cough, nausea, itchiness, a rash, loss of appetite, constipation, joint pain, and diarrhea.
Other serious side effects are rarer.
Some people may experience an allergic reaction during infusion and should tell a doctor if they experience wheezing, difficulty breathing, fever, chills, or dizziness.
ipilimumabPeople will receive other medications alongside this treatment. These could include chemotherapy, the PD-1 inhibitor nivolumab, or both.
People will receive ipilimumab intravenously, usually every 6 weeks.
Common side effects include tiredness, diarrhea, a rash, and itchiness.
Other serious side effects happen more frequently than in the drugs above.
The immune system may attack other parts of the body, causing problems in other organs.
A person may also experience the same symptoms of allergic reaction to this medication as above.

Immunotherapy is a cancer treatment that may extend the life of those with NSCLC. The medication works to keep cancer cells from preventing immune system cells from killing them.

Because not all people are a good fit for immunotherapy and the medications may cause severe side effects, doctors will carefully evaluate if immunotherapy could benefit a person with NSCLC.