*Please note: This slide show represents a visual interpretation and is not intended to provide, nor substitute as, medical and/or clinical advice.

Is immunotherapy the right treatment for your non-small cell lung cancer? The first step in finding out is for your doctor to do a complete evaluation. This will include tests to look for genetic changes and for the checkpoint protein PD-L1 in your tumors.

Your doctor will also consider other factors, such as

• The stage of your cancer. This is a way of measuring how much cancer is in your body.
• Whether you’ve been treated for non-small cell lung cancer before and what kind of treatment you received.

Your doctor will check to see if your tumor has certain genetic changes, such as changes in proteins called EGFR or ALK. If it does, your doctor may recommend that you get targeted therapy first because it will do the best job of shrinking your tumor.

Targeted therapy uses drugs to attack abnormal changes in certain genes in the cancer cells. Like immunotherapy, targeted therapy is a kind of precision medicine. Precision medicine means treatment that is tailored to the precise features of your cancer.

Your doctor may recommend that you start treatment for advanced non-small cell lung cancer with an immunotherapy drug when

• Your tumor doesn't have the proteins EGFR or ALK.
• You have not been treated for NSCLC before.
• Your cancer has spread to other organs.

Your doctor may recommend treatment with immunotherapy alone or with immunotherapy plus chemotherapy.

Your doctor may recommend treatment with the immunotherapy drug durvalumab when

• Your cancer has spread into the chest or lymph nodes near the lungs but not to other organs, or
• You have had chemotherapy and radiation treatment and your cancer has not gotten worse.

Your doctor may recommend immunotherapy if your cancer has grown or come back after you have had chemotherapy, targeted therapy, or both.

Even if your cancer cells don’t have the checkpoint protein PD-L1 or have low levels of it, immunotherapy may still work for you after you have received other treatments.

Your doctor may recommend that you get both an immunotherapy drug and chemotherapy.

Clinical trials are tests to find out if a new cancer treatment is better than existing treatments. Ask your doctor if enrolling in a clinical trial is right for you.

Side effects can occur when an immunotherapy drug attacks healthy cells. Common side effects include

• Feeling tired and weak
• Pain in the muscles, joints, or stomach
• Loss of appetite
• Itching
• Diarrhea
• Skin rash

Always talk to your health care team about any side effects you are having.

Side effects of immunotherapy are often treated with prednisone, a drug that suppresses your immune system. Your immunotherapy will be stopped until the side effects clear up.

References

1. Brahmer J et al. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of non-small cell lung cancer (NSCLC). Journal for ImmunoTherapy of Cancer (2018) 6:75.
2. Gubens M & Davies M. NCCN Guidelines Updates: New Immunotherapy Strategies for Improving Outcomes in Non–Small Cell Lung Cancer. J Natl Compr Canc Netw 2019;17(5.5):574-578.
3. National Cancer Institute. Atezolizumab. 6/8/2020. https://www.cancer.gov/about-cancer/treatment/drugs/atezolizumab.
4. National Cancer Institute. Durvalumab. 3/30/2020. https://www.cancer.gov/about-cancer/treatment/drugs/durvalumab.
5. National Cancer Institute. Nivolumab. 6/17/2020. https://www.cancer.gov/about-cancer/treatment/drugs/nivolumab.
6. National Cancer Institute. Pembrolizumab. 7/9/2020. https://www.cancer.gov/about-cancer/treatment/drugs/pembrolizumab.
7. Patel J. Just Diagnosed With Lung Cancer: Answers from an Expert. 7/14/2018. https://www.cancer.net/blog/2018-06/just-diagnosed-with-lung-cancer-answers-expert.
8. Postow M, Wolchok J. Special considerations and toxicities associated with checkpoint inhibitor immunotherapy. 2020. UpToDate, Inc. https://www.uptodate.com/contents/special-considerations-and-toxicities-associated-with-checkpoint-inhibitor-immunotherapy
9. Santini FC, Rizvi H, Plodkowski A, et al. Safety and Efficacy of Re-treating with Immunotherapy after Immune-Related Adverse Events in Patients with NSCLC. Cancer Immunol Res. 2018 Sep;6(9):1093-1099.
10. Simonaggio A, Michot JM, Voisin AL, et al. Evaluation of Readministration of Immune Checkpoint Inhibitors After Immune-Related Adverse Events in Patients With Cancer. JAMA Oncol. 2019;5(9):1310-1317.