Patient resources and education
The lung is an aggressive type of cancer with the majority of patients (60%) diagnosed in stage 4. Survival of lung cancer remains dismal with a median survival of 1 to 2 years. Some patients even survive only 6 months. Broadly lung cancer is divided into Non-small cell and small cell. Small cell lung cancer usually affects smokers and is very aggressive with majority of patients dying in their first year of diagnosis. Non-Small cell lung cancer is further sub divided into squamous cell and adenocarcinoma.
30% of patients diagnosed with adenocarcinoma harbor mutations what we called driver mutations which drive cancer and different targeted therapies are available to control the disease for few years without chemotherapy.
Non driver mutated lung cancer account for 70 to 80 % where there is no gene mutation that we can target and such cancers were treated with chemotherapy alone a decade ago.
Immunotherapy brings new hope for such patients. A decade ago we would have never thought of treating such patients with lung cancer without chemotherapy, but now times have changed and we are incorporating more and more chemotherapy-free treatment for stage 4 lung cancer.
We are dedicated to research in this field and we are seeing more and more lung cancer patients survive longer without the toxic effects of chemotherapy.
How does Immunotherapy work?
It activates the body’s own immune system to fight cancer. It activates immune cells which have been put to sleep by different substances released from a cancer cell.
By blocking PD-1, these drugs boost the immune response against cancer cells. These drugs are called PD-1/PD-L1 inhibitors or checkpoint inhibitors.
The phenomenal response to immunotherapy in lung cancer with immunotherapy
How much is the benefit of Immunotherapy for lung cancer patients?
Before starting immunotherapy for a patient with lung cancer, he should know the pros and cons. It is not magic. We measure the benefit of Immunotherapy by 2 parameters. The first is response rates which means how much has tumor shrunk and the second parameter is survival. Immunotherapy will not give the cure to patients but it will prolong life and some patients survive beyond 5 years which was never seen before.
How do we know whether Immunotherapy will work or not?
There are different ways to know that what is the probability of response in a particular patient. Whether immunotherapy will work or not.
These are prognostic and predictive biomarkers and those are
1, PDL 1
3, PET CT
4, Artificial intelligence -New tool to predict response
5, Initial response to therapy
6, Previous therapies
Does Immunotherapy benefit stage 3 lung cancer patients?
Treatment of stage III Lung cancer is Chemo plus Radiation-CCRT. And now immunotherapy is given to all patients who receive CCRT for 1 year and we have seen phenomenal results with 60% of patients surviving over 5 years.
Specifically, durvalumab is intended for patients with stage 3 lung cancer that cannot be removed surgically and has not progressed after the completion of concurrent treatment with platinum-based chemotherapy and radiotherapy.
Excellent response to immunotherapy in lung cancer
Can immunotherapy benefit stage 1 and stage 2 lung cancer patients?
Yes, in near future it can be used. Clinical trials have shown excellent results and at present we use immunotherapy for the treatment of early-stage lung cancer in the context of clinical trials.
How is Immunotherapy administered?
By simple 1 hour infusion in day care. There is no need for admission. There are very less infusion reactions and does not need much pre medication.
Possible side effects?
Immunotherapy for lung cancer is not without side effects, although they are very less as compared to chemotherapy. It has side effects which are different. As immune system gets activated and kills cancer cells, it can attack other organs of body and cause inflammation of these organs although the incidence is less than 5%. One should be aware what to expect and diagnose these side effects early so they do. Mild symptoms do not need any treatment and drug should be stopped and restarted after some time not progress. Sever symptoms need medications
Most common side effects
Fatigue, diarrhea, skin rash, and itching.
Less common side effects
What is the cost of Immunotherapy and where are these drugs made?
Immunotherapy is costly and different drugs have different costs and if approved in India then there are different schemes for the patients. There are no generics available till date.
Immunotherapy drugs are made in American and imported
Can immunotherapy cure Lung cancer?
For medical oncologist and researcher’s definition of cure is different but we take 5-year survival as a good end point and few patients will survive beyond 5 years.
How long to continue Immunotherapy?
Different drugs have different protocols e.g., For pembrolizumab it is stopped after 36 cycles.
It depends on many factors
2, Side effects
3, Finances-After achieving response Immunotherapy can be stopped for some time.
What are immune check point inhibitors?
CTLA 4 Inhibitors
Nivolumab (Opdivo), pembrolizumab (Keytruda), and cemiplimab (Libtayo) target PD-1
a protein on certain immune cells (called T cells) that normally helps 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.
Atezolizumab (Tecentriq) targets 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.
These drugs can be used in different situations to treat NSCLC
What is role of Artificial intelligence in predicting response to immunotherapy in Lung cancer?
As we know that not all lung cancer patient’s response to immunotherapy, we are looking at different ways of predicting response and one latest tool is artificial intelligence which tells us about the possibility of response to such drugs.It is in its initial phase of trials and reseach but soon it will help us in predicting response .We have started using it and have seen goos results.
With newer check point inhibitors and research we will be able to help more and more patients suffering from lung cancer.
Dr. Waseem Abbas
Director research @MAX institute of cancer care.
Senior consultant medical and Hemato-oncology @MAX cance centre shalimarbagh.
Clinical lead in Medical oncology from MAX cancer centre shalimarbagh.
This has encouraged dr Abbas to dedicate himself to research in the field of immunotherapy. He has treated so far 500 patients with immunotherapy and has published research in International and National journals. Apart from that dr Abbas has done some breakthrough research in this field. Dr abbas have dedicated his life to immunotherapy research and are the pioneer of immunotherapy in India.