Immunotherapy, also known as immune oncology, is a recent advancement in treating some types of cancer. This treatment method has shown significant promise in combating lung cancer.

Lung cancer is one of the five cancers with the highest mortality rate. According to the GLOBOCAN data of 2022, it rates as the highest in mortality rate accounting for 18% of all cancer deaths. The main reason for this is the fact that it hardly shows any symptoms in its early stages. By the time the symptoms become apparent and we go for a screening, the disease has already reached the 4th stage.

Some symptoms to look out for:

• Persistent cough which does not answer to any medicine.
• Shortness of breath
• Coughing up sputum with specs of blood
• Wheezing and pain in the chest.

Regular screening and early diagnosis give a better survival rate. The American Cancer Society has given the 5-year survival rate for various stages of lung cancer.

The figures are dark and the prognosis bleak. But new researches and clinical trials have brought a ray of hope to all. Immunotherapy, the latest line in medicine, has improved the statistics. Now 80% of patients with early-stage non-small cell lung cancer survive after 5 years.

What is immunotherapy and how does it work?

To understand immunotherapy, we first need to understand the difference between cancerous cells and normal cells.

When a normal cell becomes inactive, the immune system identifies the dead cell and destroys it. One protein P35, has the function of checking if the cell is damaged and order it to self-destruct. The cancerous cells evade this, hiding, travelling through the bloodstream, and mutating.

Immunotherapy arms and trains the body’s white blood cells to recognize the mutated cells and destroy them. There are various immunotherapy drugs which are in use. They have already received FDA approval. The major line of treatment used now is the line of drugs which come under immune checkpoint inhibitors.

1) Immune Checkpoint Inhibitor

These drugs block the interaction between the PD-L1 protein and the PD-LI receptor. This interaction between the protein and receptor ‘hides’ the cancer cells and stops the immune system from recognizing it. Thus, it is easily able to undergo metastasis and travel to different organs of the body. The checkpoint inhibitors block this interaction. Now the immune system can easily identify the cancer cells and destroy them.

Other types of immuno-oncology treatments like cancer vaccines and Adoptive T-cell therapy are still at the trial stage and have not received FDA approval.

Doctors often administer the drugs intravenously (IV) in cycles, every 2 to 3 weeks. The duration of the cycle depends on the patient’s response and the side effects of the treatment.

What side effects should we expect?

The treatment has similar side effects to chemotherapy but with lesser intensity. The drugs administered are less toxic than chemotherapy.

You can experience:

• Nausea
• Vomiting
• Itchiness
• Skin rash

How effective is it for lung cancer?

The immune checkpoint inhibitors have proved very effective in the treatment of both non-small cell lung cancer (NSCLC) and extensive stage small cell lung cancer (SCLC). It has shown a promising result in survival rates. 80% of patients with early stage NSCLS, treated with immunotherapy and surgery, survived after 5 years. Long-term survival is possible in over 15% of patients treated with immunotherapy.

Doctors often combine other treatment approaches such as surgery, radiation, and chemotherapy with this treatment.

Can it cure 4th stage lung cancer?

Immunotherapy drugs are rarely curative for 4th stage lung cancer. It slows down the spread and growth of the cancer cells and hence provides you with an improved quality of life. It may also lead to long term remission, depending on your overall health. Your oncologist would decide which type of treatment is suitable for you.

What factors decide if you are eligible?

Your oncologist would decide your line of treatment based on certain factors.

• The type and the stage of the cancer.
• The presence of biomarkers like PD-L1.
• Your overall health and medical history.

What is the cost and accessibility of the treatment?

Immunotherapy is an expensive treatment, and combined with other treatments like surgery, radiation, and chemotherapy, places a heavy financial burden on the patient and the family.

Cost in India:

Rs. 1,50,000 to 4,50,000 per cycle. The treatment is given in intravenously (IV) in cycles every 2-3 weeks. The modality of the treatment usually depends on your oncologist and the stage of the disease.

Is Insurance Available?

There are some insurance companies which provide cover for cancer treatment. They also cover immunotherapy. Some policies are:

• New India Assurance Cancer Guard policy
• Star Health Arogya Sanjeevani policy

There is also the central government health scheme and provisions for a medical loan. It is always advisable to read the terms and conditions in finer print and talk directly to the hospital TPA.

A Helping Hand

Cancer patients usually feel very isolated. The specter of eminent death and the burden on the family mentally drains both the family and the patient.

In such a scenario, some support groups play a very important role. They aid the patient by hooking them up to a suitable oncologist, provide counselling to patient and family, and suggest affordable financial options. They also help in availing medical loans. Details of such support groups can be obtained online.

All said and done, immunotherapy has changed the paradigm in lung cancer treatment. Earlier, when the mortality rate was very high, now the success rate is 95%. Of course, the success of the treatment depends on the stage of the disease and the general health of the patient. But there also have been some miraculous recoveries.

Doctors diagnosed Omkar (name changed) with stage 4 non-small cell lung cancer. His oncologist recommended immunotherapy after studying his biomarkers. After the 2nd cycle, the scan showed his tumour had decreased considerably. He is now cancer-free and receiving treatment every nine weeks.

Similar was the case of Mr Sharma (name changed) who was diagnosed with advanced lung cancer and told he had only six months to live. With targeted immunotherapy, he has recovered and is healthy after eight years to tell his story.

However, there are still some hurdles that need to be ironed out.

The line of treatment has shown limited success in some patients.

There also have been immune-related adverse effects and the development of resistance to the drugs in some patients.

The high cost and the complexity of the treatment regime pose a challenge to both the patient and the doctor.

While facing challenges, Immunotherapy has become a beacon of hope for those battling cancer. It provides hope in situations where none existed before. Research and work in medical science continue to progress. By utilizing the body’s own defences to destroy cancerous cells, this therapy has demonstrated a significant ability to improve survival outcomes. Finding the right candidates and controlling side effects are the biggest hurdles. With medical breakthroughs, we are getting closer to more precise treatments and targeted therapies, leading us to new strategies in the fight against lung cancer.

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References:

• The author would like to thank Dr Ajay Vidyarthi (surgeon oncologist) for his advise and input
• https://www.cancer.gov
• American Lung Association - https://www.lung.org
• www.verywellhealthy.com
• www.cancerresearch.org
• pubmed.ncbi.nih.gov