Lung cancer is one of the most challenging cancers to treat. For many years, chemotherapy and radiation were the only options available. But as science evolves, so does hope. Today, immunotherapy is changing the game. Could this be the breakthrough lung cancer patients have been waiting for?
What Is Immunotherapy and How Does It Work?
Imagine your immune system as your body’s personal army. It’s designed to spot invaders like viruses, bacteria—and yes, even cancer. But cancer is sneaky. It can hide in plain sight, tricking the immune system into ignoring it. That’s where immunotherapy steps in.
Immunotherapy trains and boosts your immune system to recognize and destroy cancer cells. Think of it as giving your immune soldiers a clearer map and better weapons. Unlike traditional treatments that directly attack the tumour, immunotherapy empowers the body to fight back naturally.
Why Immunotherapy Matters in Lung Cancer
Lung cancer, particularly in its advanced stages, has been notoriously tough to treat. Chemo can slow it down. Radiation can shrink it. But recurrence and resistance are common.
Immunotherapy offers a new kind of hope—not just for longer survival, but for better quality of life. Patients who once faced grim statistics are now living longer, with fewer side effects and more energy. And for some, the results have been nothing short of miraculous.
Types of Immunotherapy Used in Lung Cancer
Not all immunotherapies are the same. Here are the main types being used:
- Immune Checkpoint Inhibitors: These block proteins like PD-1, PD-L1, or CTLA-4 that act as brakes on the immune system. By releasing these brakes, the immune system can attack cancer cells more effectively.
- Cancer Vaccines: These are designed to stimulate the immune system to target specific antigens found on cancer cells.
- Adoptive T-cell Therapy: This involves collecting and modifying a patient’s T-cells in a lab so they better recognize cancer, then returning them to the body.
- Monoclonal Antibodies: Lab-made antibodies that can bind to cancer cells and mark them for destruction.
Each approach has its role, and some are still in clinical trials. But immune checkpoint inhibitors have become a cornerstone of lung cancer care.
Immunotherapy for Non-Small Cell Lung Cancer (NSCLC)
NSCLC makes up about 85% of all lung cancer cases. Immunotherapy has become a key player here. Drugs like pembrolizumab (Keytruda) and nivolumab (Opdivo) are often used alone or alongside chemotherapy, depending on PD-L1 levels and stage of the disease.
Patients with high PD-L1 expression tend to respond better, but even those with lower levels may still benefit. In some cases, immunotherapy is now used as the first-line treatment—a major shift from just a few years ago.
Immunotherapy for Small Cell Lung Cancer (SCLC)
SCLC is more aggressive and grows faster. Historically, treatment options were limited. But now, immunotherapy is making inroads here too.
Drugs like atezolizumab (Tecentriq) and durvalumab (Imfinzi) are being combined with chemotherapy to improve survival in extensive-stage SCLC. While the gains may be modest compared to NSCLC, they still offer hope for a cancer that once had few options.
Common Drugs Used in Lung Cancer Immunotherapy
Let’s take a closer look at some of the main players in this field:
- Nivolumab (Opdivo): A PD-1 inhibitor often used in NSCLC after chemotherapy.
- Pembrolizumab (Keytruda): A PD-1 inhibitor approved as first-line therapy in patients with high PD-L1 expression.
- Atezolizumab (Tecentriq): A PD-L1 inhibitor used in both NSCLC and SCLC.
- Durvalumab (Imfinzi): A PD-L1 inhibitor used after chemoradiation in Stage III NSCLC.
These drugs have reshaped how oncologists approach lung cancer, offering real hope where few options once existed.
Who Is a Candidate for Immunotherapy?
Not everyone with lung cancer will benefit equally from immunotherapy. That’s why doctors run specific tests to guide treatment:
- PD-L1 Expression Testing: Higher levels often predict a better response to checkpoint inhibitors.
- Tumor Mutational Burden (TMB): A high TMB means the cancer has more mutations, which may make it easier for the immune system to recognize.
- Genetic Profiling: Some mutations (like EGFR or ALK) may respond better to targeted therapy than immunotherapy.
So, if you’re wondering, “Am I eligible for this?” — the answer depends on your tumour’s biology, not just its size or location.
What to Expect: The Immunotherapy Treatment Journey
Starting immunotherapy can feel overwhelming, especially with all the unfamiliar names and protocols. But the process is often simpler than it sounds:
- Delivery: Usually through an IV infusion, once every few weeks.
- Duration: Some patients continue for months, others for years.
- Monitoring: Regular scans and blood tests track how well it’s working.
Many patients report fewer side effects than with chemo. You might feel tired or get a rash. But overall, life often continues with more normalcy than other treatments allow.
Side Effects of Immunotherapy: What Patients Should Know
Even though immunotherapy is gentler than chemotherapy for many, it’s not without risks.
Common side effects:
- Fatigue
- Skin rash
- Joint pain
More serious (but rarer) immune-related issues:
- Pneumonitis (inflammation of the lungs)
- Colitis (inflammation of the colon)
- Hepatitis
- Endocrine disorders like thyroiditis
It’s important to report any new symptoms quickly. Your care team can usually manage these with steroids or treatment pauses.
Success Stories and Real-World Outcomes
Real patients are seeing real benefits. Some who were once given months to live are now celebrating years cancer-free.
Take James, a 64-year-old former smoker diagnosed with Stage IV NSCLC. After failing chemo, he started on pembrolizumab. Two years later? He’s not only alive, but playing golf every weekend.
Stories like these fuel the momentum behind immunotherapy. They’re no longer rare miracles—they’re becoming more common.
Immunotherapy in Combination with Other Treatments
Can immunotherapy work even better with other therapies? That’s exactly what researchers are exploring.
- With chemotherapy: Chemo may help release cancer antigens, making the immune response stronger.
- With radiation: Radiation may act like a “vaccine,” helping the immune system spot tumour cells.
- With targeted therapy: Still experimental, but some combinations show promise.
These strategies are all about synergy—using one tool to sharpen the effect of another.
Future Directions and Ongoing Research
What’s next? The pipeline is bursting with potential:
- New biomarkers to better predict who will respond
- Next-gen immunotherapies like bispecific antibodies
- Neoantigen vaccines tailored to each patient’s tumour
Clinical trials are ongoing all over the world. If you’re interested, ask your oncologist about eligibility. Participating in research could give you access to cutting-edge treatment.
Barriers and Challenges in Access to Immunotherapy
Let’s be honest: immunotherapy isn’t perfect. And it isn’t available to everyone.
Challenges include:
- High costs: These drugs are expensive, and insurance may not always cover them.
- Access: Not all hospitals offer the latest options, especially in rural areas.
- Limited data for some groups: More research is needed in elderly patients or those with coexisting illnesses.
As awareness grows, so does advocacy. The hope is that more patients can benefit, regardless of where they live or what they earn.
Questions to Ask Your Oncologist About Immunotherapy
Starting a new treatment can be nerve-wracking. Here are some questions to help you prepare:
- Am I a candidate for immunotherapy?
- What are the potential benefits and risks in my case?
- What tests will guide my treatment?
- Will this be combined with other therapies?
- What symptoms should I watch out for?
- What happens if it stops working?
There are no silly questions. The more informed you are, the more empowered you’ll feel.
References
- “Immunotherapy for Lung Cancer: What You Need to Know.” American Cancer Society, 2023. https://www.cancer.org/cancer/lung-cancer/treating/immunotherapy.html
- “Checkpoint Inhibitors for the Treatment of NSCLC.” National Cancer Institute, 2024. https://www.cancer.gov/about-cancer/treatment/types/immunotherapy/checkpoint-inhibitors
- Gandhi, L. et al. “Pembrolizumab plus Chemotherapy in Metastatic Non–Small-Cell Lung Cancer.” New England Journal of Medicine, 2018. https://www.nejm.org/doi/full/10.1056/NEJMoa1801005
- “How Immunotherapy Works Against Lung Cancer.” Lung Cancer Research Foundation, 2023. https://www.lungcancerresearchfoundation.org
- Paz-Ares, L. et al. “Durvalumab in Stage III NSCLC.” New England Journal of Medicine, 2017. https://www.nejm.org/doi/full/10.1056/NEJMoa1709937