Immunotherapy Tops Chemo for Advanced Lung Cancer

A targeted treatment prolongs survival, with fewer side effects.

Medically reviewed in April 2021

Updated on January 24, 2022

Many cancer treatments make patients feel worse before they feel better. Nausea, vomiting, fever, infection: All are common side effects of chemotherapy. It may extend your life, but it often comes at a price.

Thankfully, there is a newer treatment that is effective for many cases of lung cancer and often comes with fewer and less severe side effects. A December 2015 study demonstrated the power of immunotherapy for advanced lung cancer.

The study, published in The Lancet, compared two treatments: a traditional chemotherapy drug called docetaxel and an immunotherapy drug called pembrolizumab (Keytruda). About 1,000 people received either immunotherapy in a higher or lower dosage or traditional chemotherapy. The study found that people who received either of the immunotherapy doses not only lived longer but also had fewer side effects.

How does it work?
Think of the white blood cells called T-cells as the body’s guard dogs. They identify and kill anything that’s not supposed to be there, like bacteria and viruses—and also cancer cells. But some tumors release a particular protein that makes them invisible to the T-cells. Immunotherapy blocks that protein, opening up the tumor cells to attack from the immune system.

Traditional chemotherapy treatment attacks quickly dividing cancer cells by stopping their growth. The trouble is that chemo can’t tell the difference between a tumor and a normal, rapidly dividing cell, so it kills them all. That’s what explains chemo’s side effects, like increased risk of infection (it kills the immune cells that fight off infection), hair loss (it kills quickly dividing hair cells), and nausea, diarrhea, and vomiting (it kills quickly dividing stomach and intestinal cells).

What it all means
One thing is clear: Neither traditional chemotherapy nor immunotherapy is magic. Lung cancer is a serious illness that is still hard to treat. It accounts for more than a quarter of all cancer deaths.

Researchers recruited 1,034 people for the Lancet study between August 2013 and February 2015. By September 2015, just over half had died.

That said, the people getting either immunotherapy treatment did live longer than those getting chemo. Average overall survival was 8.5 months with the chemotherapy treatment. It was 10.4 months with the lower-dose immunotherapy and 12.7 months for the higher dose. Among people whose tumors have that protein that makes them invisible to the immune system, survival was even better with the immunotherapy: 14.9 months and 17.3 months for the lower and higher doses, respectively, compared to 8.2 months for the chemo treatment.

Severe, life-threatening, or fatal side effects were also far less common with immunotherapy, occurring in 13 percent for low-dose immunotherapy and 16 percent for high-dose immunotherapy, compared to 35 percent in those who received chemo. The most common side effects associated with immunotherapy were decreased appetite, fatigue, nausea, and rashes. In some cases, the immune system can attack the bowels, liver, lungs, kidneys, adrenal and pituitary glands, heart, and pancreas. 

Pembrolizumab isn’t right for everyone. But it’s currently being used for at least 18 specific cancers, including stage IV non-small cell lung cancer and melanoma. If your cancer has spread from where it started (metastasized), this form of immunotherapy may be right for you. Talk to your oncologist to find out your options.

Article sources open article sources

Herbst RS, Baas P, Kim DW, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet. 2016;387(10027):1540-1550.
Keytruda.com. Accessed Jan. 21, 2022.

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