When is immunotherapy used in NSCLC?

Immunotherapy is the use of medicines to help a person’s own immune system to recognize and destroy cancer cells more effectively. These drugs are known as immune checkpoint inhibitors. 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. There are two main types of immunotherapy that can be used to treat NSCLC:

• PD-1/PD-L1 inhibitors
• CTLA-4 inhibitors

There are three PD-1 inhibitors that target PD-1, a protein on certain immune cells (called T cells) that normally help 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. These drugs can be used in different situations to treat NSCLC. In some cases, before one of these drugs can be used, lab tests might need to be done on the cancer cells to show they have at least a certain amount of the PD-L1 protein (which would mean these drugs are more likely to work).

• Nivolumab (Opdivo^®) can be used along with chemotherapy as a first treatment before surgery in people with certain early-stage NSCLCs. Nivolumab can also be an option as the first treatment in some people. It is given along with CTLA-4 inhibitor ipilimumab (Yervoy), which is described below, sometimes along with chemo as well. Nivolumab also be used in people with certain types of advanced NSCLC whose cancer starts growing again after chemotherapy or other drug treatments.
• Pembrolizumab (Keytruda^®) can be used (sometimes with chemo) as part of the first treatment in some people with metastatic NSCLC and in people with certain types of advanced NSCLC whose cancer starts growing again after chemotherapy or other drug treatments. For people with stage III NSCLC who cannot have surgery or chemotherapy with radiation, pembrolizumab can be given as the first treatment.
• Cemiplimab (Libtayo^®) can be used (sometimes with chemo) as part of the first treatment in some people with metastatic NSCLC. For people with stage III NSCLC who cannot have surgery or chemotherapy with radiation, cemiplimab can be given as the first treatment.

There are two PD-L1 inhibitors that target PD-L1, a protein related to PD-1 that is found on some tumor cells and immune cells. Blocking this protein can help boost the immune response against cancer cells. This can shrink some tumors or slow their growth.

• Atezolizumab (Tecentriq^®) can be used (sometimes with chemo) as part of the first treatment in some people with metastatic NSCLC and in people with certain types of advanced NSCLC whose cancer starts growing again after chemotherapy or other drug treatments. Atezolizumab can be used in people with stage II or early-stage III NSCLC who have already been treated with surgery followed by chemotherapy. The use of this drug after surgery is known as adjuvant therapy.
• Durvalumab (Imfinzi^®) can be used in people with stage III NSCLC whose cancer cannot be removed with surgery and has not gotten worse after they have received chemotherapy with radiation (chemoradiation). The goal of treatment with this drug (also called consolidation therapy) is to keep the cancer from getting worse for as long as possible.

There is one CTLA-4 inhibitor that boosts the immune response by blocking CTLA-4, another protein on T cells that normally helps keep them in check available for the treatment of NSCLC.

• Ipilimumab (Yervoy^®) can be used along with the PD-1 inhibitor nivolumab (Opdivo^®), with or without chemo, to treat certain types of advanced NSCLC, but it’s not used alone.

All of immunotherapy drugs are given as an intravenous (IV) infusion. Depending on the drug, they might be given every 2, 3, 4, or 6 weeks.