IMMUNOTHERAPY FOR THE TREATMENT OF LUNG CANCER BOOKLET SUPPLEMENT Immunotherapy stages. At the time of this booklet’s Immunotherapy is one of the most printing, the FDA has approved exciting new approaches for treating two immunotherapy drugs for the several types of cancer, including treatment of metastatic non-small lung cancer. Immunotherapies work cell lung cancer if chemotherapy by boosting your body’s own natural is no longer working: nivolumab defenses to fight cancer. Several (Opdivo®) and pembrolizumab immunotherapies are currently being developed and tested in clinical trials for a variety of lung cancer types and
2015 Free to Breathe (Keytruda®). Pembrolizumab has What is the Immune System been approved only for patients with and How Does It Work? metastatic non-small cell lung cancer Your immune system is a network of whose tumor has tested positive for the specialized cells, tissues, and organs marker PD-L1. Other similar drugs are working together to defend your body under development and are likely to be from foreign invaders. It does this approved soon. For these treatments, through its ability to recognize things patients with cancer that tests positive that do not belong in the body, such as for EGFR or ALK mutations should bacteria, viruses, or cancer cells. The receive targeted therapies specific for frontline of the immune system includes these mutations before immunotherapy cells circulating in your bloodstream is considered. Keep in mind that these — known as white blood cells. There treatments for lung cancer are still new, are a number of different types of therefore more research must be done white blood cells, all of which attack to understand which people are most foreign substances in different ways. likely to benefit and how best to use the Lymphocytes are one of the main cell treatments. Ask your doctor if there are types of the immune system, and they any available immunotherapy treatments are particularly important in fighting or clinical trials that might be right for cancer. One type of lymphocyte, you. called T-lymphocytes or T-cells, have specialized structures on their surface that can recognize when a cell is infected or is a cancer cell. When this happens, the T-cell starts a process leading to the destruction of the infected or cancerous cell. (Figure 1)
2015 Free to Breathe WHAT’S SUPPOSED TO HAPPEN Figure 1A. Lymphocytes recognize the cancer cell as something that is not supposed to be there... Lymphocyte
Lymphocyte Cancer Cell
Lymphocyte =PD-1
Figure 1B. ...and become activated to help destroy the cancer cell.
Activated Lymphocyte
Activated Cancer Cell Lymphocyte
Activated Lymphocyte
2015 Free to Breathe How Does Immunotherapy found on T-cells and helps to regulate Work? the immune response. Under normal circumstances, PD-1 binds to another Because the immune system can be protein called PD-L1, which helps “turn so powerful, the body has control off” the T-cells so that they don’t attack mechanisms in place to prevent it from normal body organs and tissues. accidentally attacking normal, healthy tissues, such as the joints, bowels, or In some cases, cancer cells can find skin. One way this happens is through ways to use these control mechanisms proteins found on the cells of the body to trick the immune system into thinking called “checkpoint proteins.” PD-1 that they are “normal” and should not is a type of checkpoint protein that is
WHAT’S SOMETIMES HAPPENS
Cancer cell secretes proteins that make lymphocytes and other immune cells unable to “see” the cancer cells.
Blinded Lymphocyte
Blinded Lymphocyte Cancer Cell
Blinded Lymphocyte =PD-L1
2015 Free to Breathe be attacked. One way they do this the result is the same: PD-L1 and PD-1 is by producing their own PD-L1. If a can no longer bind to each other, cancer cell produces this protein and allowing the T-cells to recognize the that PD-L1 binds to PD-1 (Figure 2), tumor cells and destroy them. Your the T-cell no longer recognizes the doctor may recommend testing your cancer cell as something foreign. The tumor for PD-L1 before prescribing T-cell becomes inactivated and will one of these treatments. Some studies no longer attack, making the cancer suggest that this test may help your cells “invisible” to the patrolling T-cells, doctor determine if immunotherapy is allowing them to escape. This allows right for you. cancer cells to continue to grow and It is important to remember that spread. immunotherapies work differently Researchers have developed several from chemotherapy. When a patient strategies for strengthening the immune receives chemotherapy, changes in system against tumors. One such the size of a tumor can be measured strategy is to prevent cancer cells quickly, often within days. With from making themselves “invisible.” immunotherapy, the benefits can Drugs that use this strategy, such take much longer to recognize. as nivolumab (Opdivo®) and Researchers aren’t sure exactly why pembrolizumab (Keytruda®), are this happens, but it may be because sometimes called “checkpoint the immune response takes a little inhibitors.” while to become fully active. In some patients, immunotherapy causes T-cells Nivolumab and pembrolizumab work and other immune cells to flock to the by binding to the PD-1 on T-cells so tumor, making it appear to actually get that they are no longer available to larger before it begins to shrink. Your bind with PD-L1 (Figure 3A). That doctor will work with you to determine reduces the cancer cell’s ability how to best monitor your progress to trick the immune system. Some while you are on an immunotherapy. immunotherapies under development work by binding to PD-L1 instead of to PD-1 (Figure 3B), but in either case,
2015 Free to Breathe WITH IMMUNOTHERAPY, THE GOOD GUYS WIN Figure 3A. Immunotherapy agents such as nivolumab and pembrolizumab stick to PD-1 so it can’t interact with PD-L1.
Lymphocyte
Lymphocyte
Cancer Cell
Lymphocyte = anti PD-1
Figure 3B. Other immunotherapies are in development that bind to PD-L1 and also inhibit PD-1 from binding to PD-L1.
Lymphocyte
Lymphocyte
Cancer Cell
Lymphocyte = anti PD-L1 2015 Free to Breathe What Side Effects Can Occur result in your body’s own defenses With Immunotherapy? attacking normal organs. This is most commonly seen in the lungs, liver, Because immunotherapies work by intestines, kidney or hormone glands. enhancing or turning on the immune When this happens, conditions such system, they can sometimes cause your as pneumonitis, a lung problem with immune system to become overactive symptoms of cough, chest pain, or and attack normal tissues or organs. shortness of breath, or colitis, an This can be a particular concern in intestinal problem that can result patients who have had an organ in diarrhea or tears or holes in the transplant or who already have immune intestine, can occur. Be sure you talk system problems such as Crohn’s to your doctor about any concerns or disease, ulcerative colitis, or lupus. side effects you experience during your You should discuss with your doctor treatment. if you have experienced any of these before starting an immunotherapy. The most common side effects patients experience with immunotherapies are mild and can include fatigue, itching, skin rashes, muscle, joint or bone pain, and nausea. In rare cases, the immune system over-reacts, which can cause more serious side effects if they
2015 Free to Breathe