When is immunotherapy used for NSCLC?

What is immunotherapy?

Immunotherapy (IO) is the use of medicines that help your immune system find and kill cancer. One type of IO drug is known as immune checkpoint inhibitors (ICIs).

An important role of the immune system is to keep itself from killing normal cells in the body. To do this, it uses “checkpoints” that allow it to be turned on or off. Cancer cells sometimes use these checkpoints to hide from the immune system.

There are three types of ICIs used to treat NSCLC:

Anti-PD-1
Anti-PD-L1
Anti-CTLA-4

Anti-PD-1 Drugs

Three anti-PD-1 drugs are approved to treat NSCLC: cemiplimab (Libtayo^®), nivolumab (Opdivo^®), and pembrolizumab (Keytruda^®). These drugs target PD-1, a protein on certain immune cells (called T cells) that normally helps to keep these cells from attacking other cells in the body. By blocking PD-1, these drugs boost the immune response against cancer cells. This can shrink some tumors or slow their growth. Before one of these drugs is used, lab tests are done that help your doctor know if and how to use these drugs. Click on each of the anti-PD-1 drug names below to learn more about how they are used to treat NSCLC.

Cemiplimab (Libtayo^®)

Cemiplimab (Libtayo^®) may be used:

With chemotherapy that contains a platinum medicine as your first treatment for NSCLC that:
- has not spread outside your chest (locally advanced lung cancer), if you cannot have surgery or chemotherapy with radiation, or
- has spread to other areas of your body (metastatic lung cancer), and
- does not have an abnormal EGFR, ALK, or ROS1 gene
Alone, as your first treatment for NSCLC that:
- has not spread outside your chest (locally advanced lung cancer), if you cannot have surgery or chemotherapy with radiation, or
- has spread to other areas of your body (metastatic lung cancer), and
- tests positive for high PD-L1, and
- does not have an abnormal EGFR, ALK, or ROS1 gene

Pembrolizumab (Keytruda^®)

Pembrolizumab (Keytruda^®) may be used:

With the chemotherapy medicines pemetrexed and a platinum chemo drug as your first treatment when your lung cancer:
- has spread (advanced NSCLC), and
- is a type called “non-squamous”, and
- does not have an abnormal EGFR or ALK gene
With the chemotherapy medicines carboplatin and either paclitaxel or paclitaxel protein-bound as your first treatment when your lung cancer:
- has spread (advanced NSCLC) and
- is a type called “squamous”
Alone, as your first treatment when your lung cancer:
- has not spread outside your chest (Stage III), if you cannot have surgery or chemotherapy with radiation, or
- has spread to other areas of your body (advanced NSCLC), and
- tests positive for PD-L1, and
- does not have an abnormal EGFR or ALK gene
Alone, when:
- you have received chemotherapy that contains platinum to treat your advanced NSCLC, and it did not work or it is no longer working, and
- your tumor tests positive for PD-L1 expression, and
- if your tumor has an abnormal EGFR or ALK gene, you have also received an EGFR- or ALK-inhibitor medicine and it did not work or is no longer working
With chemotherapy that contains platinum and another chemotherapy medicine:
- before surgery when you have early-stage NSCLC that can be removed by surgery, and
- continued alone after surgery to help prevent your lung cancer from coming back
Alone, to help prevent your lung cancer from coming back after:
- your tumor(s) has been removed by surgery and you have received platinum-based chemotherapy, and
- you have Stage IB and your tumor(s) is 4 cm or greater in size, Stage II, or Stage IIIA NSCLC

Nivolumab (Opdivo^®)

Nivolumab (Opdivo^®) may be used:

With chemotherapy that contains platinum and another chemotherapy medicine before surgery for early-stage NSCLC
With chemotherapy that contains platinum and another chemotherapy medicine for early-stage NSCLC that does not have an abnormal EGFR or ALK gene before surgery, and may be continued alone after surgery to help prevent the NSCLC from coming back
With ipilimumab (Yervoy^®) as the first treatment for NSCLC that:
- has spread to other parts of your body (metastatic), and
- is positive for PD-L1, and
- does not have an abnormal EGFR or ALK gene
With ipilimumab and 2 cycles of chemotherapy that contains platinum and another chemotherapy medicine, as the first treatment for NSCLC that:
- has spread, or comes back, and
- does not have an abnormal EGFR or ALK gene
Alone for NSCLC that:
- has spread, and
- has grown on chemotherapy that contains platinum, and it did not work or is no longer working, and
- has an abnormal EGFR or ALK gene and that has grown on an EGFR- or ALK-inhibitor medicine

Anti-PD-L1 Drugs

Two anti-PD-L1 drugs are approved to treat NSCLC: atezolizumab (Tecentriq^®) and durvalumab (Imfinzi^®). Click on each of the anti-PD-L1 drug names below to learn more about how they are used.

Atezolizumab (Tecentriq^®)

Atezolizumab (Tecentriq^®) may be used:

Alone, for NSCLC that is stage 2 to stage 3A and tests positive for PD-L1, to help prevent it from coming back after surgery and platinum-based chemotherapy
Alone, as the first treatment for NSCLC that:
- has spread or grown, and
- tests positive for high PD-L1 expression, and
- does not have an abnormal EGFR or ALK gene
With bevacizumab (Avastin^®), paclitaxel, and carboplatin as the first treatment for NSCLC that:
- has spread or grown, and
- is a type called “non-squamous NSCLC”, and
- does not have an abnormal EGFR or ALK gene
With paclitaxel protein-bound and carboplatin as the first treatment for NSCLC that:
- has spread or grown, and
- is a type called “non-squamous NSCLC”, and
- does not have an abnormal EGFR or ALK gene
Alone, for NSCLC:
- that has spread or grown during or after chemotherapy that contains platinum, and
- for tumors with an abnormal EGFR or ALK gene, that has spread or grown on an FDA-approved therapy for tumors with these abnormal genes

Durvalumab (Imfinzi^®)

Durvalumab (Imfinzi^®) may be used:

With chemotherapy that contains platinum prior to surgery and alone after surgery for NSCLC that:
- can be removed by surgery, and
- is not known to have an abnormal EGFR or ALK gene
Alone, for NSCLC that:
- has not spread outside your chest
- cannot be removed by surgery, and
- has responded or stabilized with initial treatment with chemotherapy that contains platinum, given at the same time as radiation therapy
With tremelimumab (Imjudo^®) and chemotherapy that contains platinum for NSCLC that:
- has spread to other parts of your body (metastatic), and
- does not have an abnormal EGFR or ALK gene

Anti-CTLA-4 Drugs

CTLA-4 inhibitors boost the immune response by blocking CTLA-4, another protein on T cells that normally helps slow down the immune system. Two anti-CTLA-4 drugs are approved to treat NSCLC: ipilimumab (Yervoy^®) and tremelimumab (Imjudo^®). Click on each of the anti-CTLA-4 drug names below to learn more about how they are used.

Ipilimumab (Yervoy^®)

Ipilimumab (Yervoy^®) may be used:

With nivolumab (Opdivo^®) as the first treatment for NSCLC that:
- has spread to other parts of the body (metastatic), and
- is positive for PD-L1, but does not have an abnormal EGFR or ALK gene
With nivolumab and 2 cycles of chemotherapy that contains platinum and another chemotherapy medicine, as the first treatment for NSCLC that:
- has spread or grown, or comes back, and
- does not have an abnormal EGFR or ALK gene

Tremelimumab (Imjudo^®)

Tremelimumab (Imjudo^®) may be used:

With durvalumab (Imfinzi^®) and chemotherapy that contains platinum for NSCLC that:
- has spread to other parts of your body (metastatic), and
- does not have an abnormal EGFR or ALK gene

All ICIs are given in the vein. Atezolizumab, nivolumab, and pembrolizumab are also available as skin injections. Depending on the drug, they might be given every 2, 3, 4, or 6 weeks.