Immune checkpoint inhibitors for advanced non–small-cell lung cancer

Immune checkpoint inhibitors are medicines that use the body's immune system to treat some types of cancer. They belong to a group of medicines called immunotherapy.

Immune checkpoint inhibitors are 1 of the new treatment options for people with locally advanced and metastatic NSCLC. There are 3 immune checkpoint inhibitors for advanced NSCLC available in Aotearoa New Zealand:

• Keytruda (also called pembrolizumab).
• Tecentriq (also called atezolizumab).
• Imfinzi (also called durvalumab).

Note: To have access to these treatments you will have to meet the eligibility criteria. Talk to your healthcare provider about this. 

The immune system helps to protect your body from viruses and bacteria and also helps your body recognise tumour cells. 

• Immune checkpoints are proteins that naturally occur in your body and assist with the immune response.
• These checkpoints prevent your immune system from attacking healthy cells by mistake.
• However, some cancer cells can alter these checkpoints so they're not recognised by the immune system.
• Immune checkpoint inhibitors are medicines that work by blocking these checkpoints, so the immune system can attack cancer cells.

You can see how immune checkpoint inhibitors work in this video. It may take a few moments to load. 


(National Cancer Institute, US, 2018)

Chemotherapy attacks cells as they divide and can kill both cancerous and healthy cells in the process. This makes it a cytotoxic treatment.

Immune checkpoint inhibitors don't directly kill cells. Instead, they work by helping the immune system recognise and attack cancer cells.

Immune checkpoint inhibitors can differ in their action because they block different checkpoint proteins and are used in different ways.

Keytruda (pembrolizumab)

Keytruda blocks PD-1 (programmed cell death protein 1). It's funded for the treatment of advanced NSCLC. It's the preferred (or first-line) treatment for people who meet the criteria. Read more about Keytruda(external link).

Tecentriq (atezolizumab) and Imfinzi (durvalumab)

Tecentriq and Imfinzi block PD-L1 (programmed cell death ligand 1). Tecentriq is funded for people with advanced NSCLC as second (or later line) treatment. This means it's used in people who have previously received chemotherapy for their advanced NSCLC. Imfinzi is funded for locally advanced NSCLC after radiotherapy.  Read more about Tecentriq and Imfinzi. 

Immune checkpoint inhibitors can cause a range of side effects. These side effects are generally related to the activation of the immune system and can range from mild to severe. 

You may experience side effects at any time during your treatment or even months after treatment has finished. Some side effects go away within a few days or weeks and some may be longer lasting. It's important to report any side effects to your oncology team right away even if they appear mild.  Don't manage these side effects on your own.

The chances of getting these side effects also differs between the medicines:

• Keytruda has been associated with a higher chance of inflammation of the lung (pneumonitis) than Tecentriq.
• Tecentriq has been associated with a higher risk of liver problems.

Note: To monitor your side effects, you'll need monitoring and blood tests to check your thyroid, liver, kidneys and blood before you start treatment and regularly while you're receiving treatment.