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

Key points about immune checkpoint inhibitors

  • Immune checkpoint inhibitors are medicines that use the body's immune system to treat some types of cancer such as advanced non–small-cell lung cancer (NMCLC).
  • They belong to a group of medicines called immunotherapy.
  • Find out how they are given and possible side effects. 
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There are many treatment options for advanced non–small-cell lung cancer (NSCLC). The treatment choices will depend on many things.

These include:

  • the size and type of the tumour
  • where it is in your lung
  • which lymph nodes it has spread to
  • your overall health
  • how well you are tolerating treatment.

This page has information about immune checkpoint inhibitors, which are 1 treatment option for advanced NSCLC.

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. 

Common side effects

Report any side effect to your oncology team right away even if they appear mild. Don't manage these side effects on your own:

  • feeling very tired and weak (fatigue)
  • feeling sick (nausea)
  • runny poo (diarrhoea)
  • skin rash, itching
  • decreased appetite
  • joint pain
  • headache
  • cough.
Rare, serious side effects

In some people, these side effects could be life threatening. If you have any of the side effects mentioned below OR any new or worsening symptoms, contact your healthcare team or Healthline on 0800 611 116 straight away:

  • New or worsening cough, shortness of breath, and chest pain (signs of an inflamed lung or heart).
  • Blood in your poo, severe pain in your tummy or back (signs of an inflamed gut or pancreas).
  • Weight loss, weight gain, changes in mood, changes in eyesight and vision, increased sensitivity to cold or heat, slow or rapid heart rate, hair loss (signs of thyroid problems).
  • Neck stiffness, headache, vomiting, eye sensitivity to light, confusion and sleepiness (signs of inflammation of the brain or spinal cord).
  • Sore back or pain passing urine (pee), cloudy pee, or swelling of your ankles (signs of inflamed kidneys).
  • Muscle weakness, numbness or tingling in hands and feet (signs of problems with your nerves).
  • Swelling or burning feeling on your skin, ulcers in your mouth or lips, genital or anal areas, purple spots on the skin, blisters or peeling (signs of a severe skin reaction).
  • Yellow eyes or skin, dark pee, pain or discomfort in the tummy area (signs of liver problems).

Note: This is not a full list of side effects and side effects can vary in different people. If you don't know whether your symptoms are side effects of the medicine, contact your healthcare team straight away.

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Credits: Healthify He Puna Waiora editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Healthify clinical advisors

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