Immunotherapy Tops Chemo for Advanced Lung Cancer

Immunotherapy Tops Chemo for Advanced Lung Cancer

Many cancer treatments are often almost as bad as the disease. Nausea, vomiting, fever, infection: All are common side effects of chemotherapy. It may extend your life, but it often comes at a price.

A study published in December 2015 has shown the power of a new treatment called immunotherapy for advanced lung cancer. Lung cancer  represents more than a quarter of all cancer deaths.

The study, published in The Lancet, compared two treatments: a traditional chemotherapy drug called docetaxel and an immunotherapy drug called pembrolizumab, (the same medication President Jimmy Carter received for his melanoma). 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 lived longer and had fewer side effects.

How does it work?
You can consider the white blood cells known as T-cells the guard dogs of the body. They identify and kill anything that’s not supposed to be there, like bacteria and viruses—and also cancer cells. However, 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.

Traditional chemotherapy treatment attacks quickly dividing cancer cells by stopping their growth. Chemo can’t tell the difference between a tumor and a normal, rapidly dividing cell, however, and it kills them all. That’s why chemo has 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 must be made clear: Neither the traditional chemotherapy treatment nor the immunotherapy treatments are magic. Researchers recruited 1,034 people for the study between August 2013 and February 2015. By September 2015 just over half had died. 

That said, the people getting either immunotherapy treatment lived 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 35 percent who received chemo, 13 percent for low-dose immunotherapy and 16 percent for high-dose immunotherapy. The most common side effects associated with immunotherapy were decreased appetite, fatigue, nausea and rashes. One 2010 study put the rate of severe side effects at nearly 20 percent. 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, though. It’s currently being used for stage IV non-small cell lung cancer and melanoma. That means that if your cancer has spread from where it started (metastasized), this form of immunotherapy may be right for you. It’s also used for melanoma that can’t be operated on, and for lung cancer that hasn’t been knocked out by other treatments. Talk to your oncologist to find out your options.

Medically reviewed in February 2019.

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