Treatment of Lung Cancer

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Immunotherapy

For people who have advanced NSCLC, doctors may consider a treatment type called immunotherapy. It is a relatively new development in cancer treatment used to boost a person’s immune system so it will recognise and kill cancer cells.1

The immune system’s ability to detect and destroy abnormal cells usually prevents cancers from developing. However, some cancer cells find ways to stop the immune system destroying them and then the natural immune response to cancer cells may not be strong enough to fight them off.1 An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses checkpoint proteins on immune cells, which act like switches that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system.1 Drugs that target checkpoint proteins on immune cells (called checkpoint inhibitors) can be used to treat some people with NSCLC.1

For doctors to know which treatment to prescribe for a lung cancer patient, including immunotherapy, a type of testing known as biomarker testing is required. If you are unsure if you are a candidate for immunotherapy, ask your doctor if it is a suitable treatment option for you. Immunotherapy can be used by itself or in combination with traditional chemotherapy.

Recent advancements have also demonstrated that immunotherapy can improve survival outcomes for certain patients, compared to chemotherapy alone. This tailored-to-fit approach has significantly changed the lung cancer treatment model to improve patient outcomes.1

How checkpoint inhibitors work1
  • Cancer cells sometimes disguise themselves or block the immune system. The immune system controls activity of the cancer-fighting lymphocytes, called T cells, through a pathway known as ‘PD-1’. But some cancer cells block T cell attack by taking control of the pathway.
  • PD-1 is a checkpoint protein on T cells. It normally acts as an “off switch” that helps keep the T cells from attacking other cells in the body by attaching to PD-L1, a protein on some normal (and cancer) cells. When this binding happens, a signal is sent to stop the T cell from attacking the other cell. Some cancer cells possess large amounts of PD-L1 and are therefore able to avoid T cell attack. These cancer cells are then free to grow and metastasise.
Understanding if immunotherapy is right for you2

Immunotherapy is not for everyone. When considering immunotherapy, your doctor will evaluate your medical history before recommending the most suitable course of action for you. Your doctor may ask:

  • If you have any existing autoimmune conditions (e.g. lupus, rheumatoid arthritis, or Crohn’s disease)
  • If you have had a prior organ transplant
  • You to provide an overview of your liver health history
  • If you are taking any other medications (e.g. steroids and other prescription medicine, non-prescription medicine such as vitamins and herbal supplements)
Other types of immunotherapy3
  • Cancer vaccines specifically for lung cancer are still in the research and development phase. The way the vaccine is supposed to work is to prevent or to combat cancer in the body. If approved, these vaccines can be administered into the body to spur an immune response against cancer cells. Research into such vaccines, also known as therapeutic cancer vaccines, has the potential to uncover an anti-cancer vaccine.
  • Adoptive cell transfer (ACT) extracts and uses a patient’s own immune cells to treat their cancer. There are several types of ACT, including CAR (chimeric antigen receptor) T-cell treatment, currently undergoing various trials for different types of cancers—including lung cancer.

References
1 American Cancer Society. Immunotherapy for Non-Small Cell Lung Cancer. Retrieved October 2020 from https://www.cancer.org/cancer/lung-cancer/treating-non-small-cell/immunotherapy.html
2 Oncology Nursing News. Immunotherapy in Cancer Care: Educating Patients About What to Expect. Retrieved October 2020 from https://www.oncnursingnews.com/publications/oncology-nurse/2015/june-2015/immunotherapy-in-cancer-care-educating-patients-about-what-to-expect
3 Cancer Research Institute. Immunotherapy Treatment Types. Retrieved October 2020 from https://www.cancerresearch.org/immunotherapy/treatment-types

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