Immunotherapy and Its Evolving Role with Lung Cancer Treatment

Immunotherapy is a promising treatment for lung cancer. The concept isn’t new. Since the 1970s, doctors have turned to medicine as a tool to stimulate the immune system’s defensive response to cancer. In the past, immunotherapy was used to treat kidney cancer and melanoma.

It is only recently that researchers have found ways to apply the same principles to treating certain types of lung cancer.

Changing the Treatment Outlook for Lung Cancer

Although there are several treatment options doctors can use to treat lung cancer, it isn’t unusual for these cancers to stop responding to chemotherapy after a few months. Fortunately, medical research indicates that immunotherapy might be an option when other methods of treatment prove ineffective.

In 2012, researchers reported encouraging results in a small percentage of people who used immunotherapy to treat non-small cell lung cancer. Other studies involved subsets of patients who lived for many years after receiving immunotherapy when their cancer did not respond to chemotherapy.

Whereas most developments in cancer care produce marginal improvements, immunotherapy has proven to offer dramatic, durable benefits to a limited group of patients. In fact, some patients have lived for several years beyond what would have been possible with conventional treatments.

Some patients in these groups tolerate immunotherapy medicines better than chemotherapy drugs, with fewer side effects, which means they can fight their cancer while enjoying a better quality of life.

Limitations of Immunotherapy

The challenge with immunotherapy is that it seems to work only for a minority of cancer patients. Doctors don’t always know which patients will respond to immunotherapy, although several medical studies are underway to identify which cancers and which patients respond to different immunotherapies.

Research has shown that some cancers express a particular protein called PD-L1 that predicts response to certain immunotherapy drugs. This test can be ordered by your physician.

Who Does Immunotherapy Work For?

For patients whose lung cancer expresses PD-L1, a recent study has shown immunotherapy with a drug called pembrolizumab was superior to chemotherapy as the first treatment for advanced lung cancer.

For other patients, chemotherapy may be the preferred treatment but when chemotherapy stops working, immunotherapy, with drugs like pembrolizumab, nivolumab, or atezolizumab, may be a good option. In this setting, immunotherapy would be expected to work for about 20 percent of patients. Doctors are not sure if the other 80 percent of patients will respond to other types of immunotherapy.

Clinical trials are currently studying the effects of new immunotherapy drugs and new combinations, which could become available soon.

Is Immunotherapy Right for You?

Immunotherapy isn’t right for everyone with lung cancer. If you have a serious autoimmune condition, it’s less likely to be a suitable treatment option for you. In fact, it could make your condition worse. Depending on the type of lung cancer you have, there might be other treatments that your oncologist would prefer to use instead.

Don’t rule out asking your oncologist if immunotherapy is an option for you. Most doctors are happy to discuss all available treatments with their patients and explain why they are or are not suitable. You might even be a candidate to join a clinical trial for a new immunotherapy drug.

Final Thought

If you have nonsmall-cell lung cancer, talk to your oncologist about immunotherapy. This treatment may be a good option if other treatments aren’t working for you. With new immunotherapy drugs in development, there may be an emerging medicine - or combinations of medicines - that could help control your cancer or send it into remission.

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513 or click the request a consultation button.

Immunotherapy Gave Hope for One Thymic Carcinoma Patient

It started as a nagging thought, back in November 2012. I just didn’t feel like my usual self, but I couldn’t define why, precisely. Little things crept into the cracks of my well-being and seemed to erode my vitality. I developed shortness of breath when I was climbing stairs or working out, but my breathlessness was a little more pronounced than usual. I started having episodes of high blood pressure. That seemed odd to me since I was only 52 and an endurance athlete at the time.

I have always been in tune with the deep, inner signals of my body and very aware of “doing the right things” for my health. So I guess I knew something was wrong. But denial can be a powerful force.

The Bleak Outlook of Diagnosis

One of my strongest recollections of that period of time between symptom onset and my diagnosis was an evening out with my girlfriends in mid-April 2013. They were worried about me, worried that I didn’t seem to feel myself. Of course, I had no explanation for them. I remember our conversation that evening vividly. I tried to describe an “overwhelming sense of un-wellness.” I’ll remember those words forever. Just a week later everything came crashing down. My pillar of denial lay in rubble at my feet.

When I got my diagnosis, I felt like I was sitting in my living room and someone pulled the rug out from underneath both the furniture and me, sending everything that anchored me flying into the air. What came down wasn’t me, or my furniture; it wasn’t even my living room. It was my life. My doctor told me that a CT scan had found a mass in my chest.

I heard the words that terrified me: “You have thymic carcinoma.”

"Okay, stop right there," I said to myself. "I know I didn’t just hear that."

Moments of incomprehensible shock and disbelief followed. How ironic that I actually had prayed for lymphoma. That type of cancer is at least usually treatable. But as luck and fate would have it, my doctor told me that thymic cancer is very rare and usually very aggressive.

“Thymic tumors are rare and understudied,” says Giuseppe Giaccone, MD, Ph.D. “Moreover, there is a clear distinction between the different types of thymic tumors and the most aggressive form, thymic carcinoma – which only represents about 10 percent of all thymic tumors (less than a 100 new cases each year in the United States.) Surgery is the mainstay treatment in thymic tumors, but this is often not possible in thymic carcinomas, because they are already in advanced stage when they are diagnosed. Chemotherapy is then the standard treatment, sometimes associated with radiation, but results are underwhelming, with survival rates in the range of five years.”

From Treatment to Clinical Trial

I found it difficult to stay positive about my prognosis since there was little doctors or specialists could offer at the standard cancer centers. What I did learn over the next two years was that if you need a big fish (which I certainly did), you have to go to the big ponds. As a result, I was able to do fairly well physically and mentally, despite many radiation treatments to various metastatic sites.

I participated in a clinical trial that bought me some time. I learned to live in the moment and not to project the future, or what the future might bring. I kept up on the latest advancements in diagnosis and medication and frequently asked about immunotherapy.

In December 2014, my hopes were realized. I heard about a new immunotherapy trial just for Thymic cancer patients at the Georgetown Lombardi Comprehensive Cancer Center. Dr. Giaccone was the primary investigator (author) of the trial. I was accepted into the trial, and my hopes of finding a durable solution to this disease were renewed.

”At the time, Shannon had a lot of disease in her body, but she was still in good condition and very positive spirit,” shares Dr. Giaccone. “She was a good candidate for a study with pembrolizumab, an antibody that targets the immune system by making it fight the cancer.”

"You Have No Detectable Disease"

Elation cannot adequately describe the excitement and joy I felt after just one treatment. My metastatic sites started to shrink. And in April 2016, I once again heard what I previously thought was impossible: “You have no detectable disease.”

These five words were equally shocking to my original diagnosis but in the most incredible and delightful way. Today, I am filled with gratitude and thanks not just for the blessing of physical healing but also for the restoration of hope.

For those with rare cancers my advice, like so many who fight this disease, is never to stop looking for the "next big thing." I took courage from my hours of research and from participating in clinical trials. Even though my first treatments were ultimately not the treatments, they were the bridge to the treatment that ended my cancer story. So never, ever give up. Persistence pays off.

Shannon's full story can be viewed here: 

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.

How Immunotherapy Gave Leta Brown Her Life Back

Leta Brown had a wonderful life, along with her husband, two daughters and her stepson. But when she was diagnosed with widely metastatic melanoma, she felt the rug had been pulled out from under her and her family. “It was a huge jolt,” Leta shared. “I was left with a really grim prognosis. I wasn’t prepared for that kind of news.”

In April of 2013, a lumpy bruise appeared on the back of her leg. She consulted with her primary care physician, and a leg MRI showed a large metastatic tumor deposit and body CT scans showed additional metastases to her lungs and small intestines.

“When I got the news, it was really hard to get past the finality of it,” Leta said. “That this was going to take away my daughters' mother."

Immunotherapy Clinical Trial with Dr. Atkins

Not long after, while looking for treatment options, she came across an article on immunotherapy. She then found an immunotherapy trial with Dr. Michael Atkins at Georgetown Lombardi Comprehensive Cancer Center, for which she was eligible, due to her diagnosis, as well as her medical and treatment history. He explained to her that cancer cells express proteins that can disable antitumor immune responses; immunotherapy blocks the function of those proteins restoring the function of the immune system so that it can eliminate the tumor cells.

Following a resection (removal) of a large bowel metastasis, Dr. Atkins and his team were able to safely initiate immunotherapy treatments in August 2013.  Her tumor deposits quickly melted away and she was able to return to her daily activities. After one year of therapy, she was disease-free and able to stop treatment without disease recurrence.

“This type of result, while at the time being considered exceptional, is fast becoming the rule rather than the exception for patients with advanced melanoma we see at Georgetown-Lombardi,” Dr. Atkins said of Leta’s outcome.

Reflecting on Her Treatment and Looking Forward

Of her treatment, Leta recalled, “Choosing an NCI-designated Comprehensive Cancer Center like Georgetown Lombardi [one of 47 in the nation and the only one in Washington, D.C.] to receive my treatment was very beneficial when dealing with the latest therapies and in managing side effects. The various departments were aware of what to expect and knew how to successfully treat the side effects. It also made it easier for me to schedule appointments and avoid traveling to multiple facilities to receive care.”

And to others who may find themselves in a similar situation, she says to try not to rush into treatment immediately following a diagnosis; seek other opinions and ask lots of questions.

“Try to let loved ones help you,” she continued. “But allow yourself to handle this experience in a way that works best for you. Well-meaning friends wanted to sit with me through treatments, but that was a time for me to be alone and process my experience without feeling the need to put on a brave face. Say yes to offers that will ease your burden, and say no when you need to.”

To this day, she still has no evidence of the disease.

“I can’t believe how fortunate I am,” Leta said. “I’m looking forward to a really long life… it’s an incredible gift.”

Leta's full story can be viewed here:

We are here to help.

If you have questions about the MedStar Georgetown Cancer Institute or are ready to schedule a consultation with one of our specialists, call us at 202-295-0513.