Immunotherapy for non–small cell lung cancer

Some people with lung cancer have immunotherapy. Immunotherapy helps to strengthen or restore the immune system's ability to fight cancer. Immunotherapy is sometimes called biological therapy.

You may have immunotherapy to:

  • stop lung cancer cells from growing and spreading

  • kill cancer cells

  • control symptoms of advanced or metastatic lung cancer

Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of immunotherapy. You may also receive other treatments.

Checkpoint inhibitors used for non–small cell lung cancer

The immune system normally stops itself from attacking normal cells in the body by using specific proteins called checkpoints, which are made by some immune system cells. PD-1 is an immune checkpoint protein that stops T cells from attacking other cells in the body. It does this by attaching to PD-L1, a protein found on some normal cells and some cancer cells.

Checkpoint inhibitor drugs may target either PD-1 or PD-L1 proteins.

These PD-1 and PD-L1 checkpoint immunotherapy drugs may be used to treat non–small cell lung cancer:

  • pembrolizumab (Keytruda)

  • nivolumab (Opdivo)

  • durvalumab (Imfinzi)

  • atezolizumab (Tecentriq)

  • ipilimumab (Yervoy)

Pembrolizumab

Pembrolizumab is used in different ways to treat different types of lung cancer:

  • To treat metastatic non–small cell lung cancer that has not had been treated with chemotherapy, pembrolizumab may be combined with carboplatin and paclitaxel or nab-paclitaxel (chemotherapy drugs).

  • To treat non-squamous cell non–small cell lung cancer that has not been treated with chemotherapy and does not have mutations in the EGFR gene or ALK gene, pembrolizumab is combined with pemetrexed and cisplatin.

  • To treat non–small cell lung cancer that has mutations in the EGFR gene (EGFR+) or ALK gene (ALK+) and that has stopped responding to a targeted therapy drug used to treat these genetic changes, pembrolizumab is used on its own.

Nivolumab

Nivolumab may be used to treat locally advanced or metastatic non–small cell lung cancer that has stopped responding to chemotherapy or has come back after chemotherapy.

It may also be used to treat non–small cell lung cancer that is EGFR+ or ALK+ that has stopped responding to a targeted therapy drug used to treat these genetic changes.

Nivolumab and ipilimumab may be used in combination with cisplatin or carboplatin plus another chemotherapy drug for metastatic non–small cell lung cancer that does not have EGFR or ALK gene mutations and has very little PD-L1 in the cancer cells.

Atezolizumab

Atezolizumab may be used alone, or in combination with bevacizumab (Avastin, Mvasi, Zirabev), paclitaxel and carboplatin as the first treatment for metastatic non–small cell lung cancer that does not have EGFR or ALK gene mutations.

It may also be used to treat locally advanced or metastatic non−small cell lung cancer that has stopped responding to chemotherapy or has come back after chemotherapy.

Atezolizumab may also be used to treat locally advanced or metastatic EGFR+ or ALK+ non–small cell lung cancer that has stopped responding to a targeted therapy drug used to treat these genetic changes.

Durvalumab

Durvalumab may be used to treat stage 3 non–small cell lung cancer that has responded to and is no longer growing after chemoradiation, in people who can't have surgery because of poor health or because of where the tumour is.

Other immunotherapy drugs used for non–small cell lung cancer

Necitumumab (Portrazza) is a type of monoclonal antibody used to treat locally advanced or metastatic squamous non–small lung cancer in people who have not yet had any treatment. It is combined with the chemotherapy drugs gemcitabine (Gemzar) and cisplatin.

Immunotherapy drugs used to treat small cell lung cancer

Immunotherapy is not used for small cell lung cancer very often. The immunotherapy drugs that target molecules in non–small cell lung cancer do not work on the molecules in small cell lung cancer. We need more research to find more drugs that are effective against small cell lung cancer.

Atezolizumab may be used in combination with the chemotherapy drugs carboplatin and etoposide (Vepesid) as the first treatment of extensive stage small cell lung cancer.

Side effects

Side effects can happen with any type of treatment for non–small cell lung cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Side effects of immunotherapy will depend mainly on the type of drug or drug combination, the dose, how it's given and your overall health. Some common side effects of immunotherapy for non–small cell lung cancer are:

  • flu-like symptoms, such as fever and chills
  • fatigue
  • skin problems, including redness, itching and dryness
  • inflammation of the lungs, thyroid, kidney, heart or intestines
  • cytokine release syndrome
  • low levels of magnesium, calcium, phosphorous or potassium in the blood (with necitumumab)
Tell your healthcare team if you have these side effects or others you think might be from immunotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Information about specific cancer drugs

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Questions to ask about immunotherapy

Find out more about immunotherapy. To make the decisions that are right for you, ask your healthcare team questions about immunotherapy.

Expert review and references

  • Stephen Lam, MD, FRCPC
  • Brahmer JR, Covindan R, Anders RA, Antonia SJ, Sagorksy S, et al. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of non-small cell lung cancer (NSCLC). Journal for ImmunoTherapy of Cancer. 2018: 6:75.
  • Sui H, Ningxia M, Wang Y, Li H, Xiaoming L, Su Y, Yang J. Anti-PD1/PD-L1 therapy for non-small cell lung cancer: toward personalized medicine and combination strategies. Journal of Immunology Research. 2018: 2018: 6984948.
  • Dong J, Li B, Lin D, Zhou Q, Huang D. Advances in targeted therapy and immunotherapy for non–small cell lung cancer based on accurate molecular typing. Frontiers in Pharmacology. 2019: 10:230.
  • Osmani L, Askin F, Gabrielson E, Li QK. Current WHO guidelines and the critical role of immunohistochemical markers in the subclassification of non-small cell lung carcinoma (NSCLC): moving from targeted therapy to immunotherapy. Seminars in Cancer Biology. 52(Pt 1): 103-109.
  • Cancer Care Ontario. Non-small Cell Lung Cancer Treatment Pathway Map. 2019: Version 2019.05.
  • Chiang A, Detterbeck FC, Stewart T, Decker RH, Tanoue L. Non–small cell lung cancer. DeVita VT Jr, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer; 2019: 48:618–670.
  • Planchard D, Popat S, Kerr, K, Novello S, Smit EF, Faivre-Finn C, et al. Metastatic non-small cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. ESMO Clinical Practice Guidelines. 2019: https://www.esmo.org/content/download/227453/3874538/1/ESMO-CPG-mNSCLC-18SEPT2019.pdf. Friday, August 28, 2020.
  • National Comprehensive Cancer Network . NCCN Clinical Practice Guidelines in Oncology: Non-Small Cell Lung Cancer (Version 3.2020) . 2020 .
  • PDQ® Adult Treatment Editorial Board . Non–Small Cell Lung Cancer Treatment (PDQ®) – Health Professional Version . Bethesda, MD : National Cancer Institute ; 2020 : https://www.cancer.gov/types/lung/hp/non-small-cell-lung-treatment-pdq.