Immunotherapy for lung cancer (Part 2): Consolidation therapy and metastatic lung cancer

Immunotherapy is a cancer treatment that uses medicines to stimulate your own immune system to detect and destroy cancer cells, helping to improve outcomes for people fighting lung cancer.

Following on from the first part, Dr Crispin Hiley, highly renowned consultant clinical oncologist and associate professor, offers a comprehensive insight into consolidation therapy and the use of immunotherapy for lung cancer in the metastatic setting, in this conclusion of a two-part series of articles on immunotherapy for lung cancer.

How is consolidation therapy utilised?

Consolidation therapy refers to the treatment that is given following radiotherapy. For example, patients with locally advanced lung cancer who cannot have surgery usually have approximately six weeks’ worth of radiotherapy and chemotherapy.

However, the PACIFIC trial showed that many of these patients also benefit from a year's worth of immunotherapy treatment. This is given intravenously every few weeks for approximately a year, with a 10 per cent absolute improvement in the number of patients who are cured of their cancer five years after their treatment. This type of consolidation immunotherapy benefits most the patients whose tumour express a marker called PDL1. This is a test that is done on some tumours from a patient, usually taken with a biopsy, before any treatment starts.

How long does it take? When is immunotherapy relevant in the metastatic setting?

The duration of immunotherapy treatment depends on how the treatment is being used and on the particular immunotherapy drug that is being used. For example, in the neoadjuvant setting, chemotherapy and immunotherapy are only given for three cycles over a course of nine weeks, whereas in the adjuvant setting (regardless if a patient is given atezolizumab or potentially, pembrolizumab), the duration of treatment after surgery is approximately one year.

Again, if immunotherapy is being used in the consolidation setting following radiotherapy (where durvalumab is usually given), the duration of treatment in these circumstances is one year's worth of treatment.

Now, in the metastatic setting (the stage 4 setting where the main aim is to keep the cancer under control for as long as possible, knowing that curing these cancers is very rarely possible), the use of immunotherapy and its duration is a bit different. For example, pembrolizumab is given every few weeks for up to two years, whereas atezolizumab is given every few weeks for as long as it is needed. This is either until the cancer gets worse and the drug is no longer of benefit for the patient; until the patient develops side effects, which means that they can no longer continue to receive that drug; or if the patient simply chooses to stop taking this immunotherapy drug.

Can it be used for all types of cancer? When it comes to stage 4 metastatic cancer, does immunotherapy cure it?

Immunotherapy can be used for all stages of non-small-cell lung cancers and most types of non-small-cell lung cancers. Certainly, immunotherapy is used for the larger tumours that are going to be removed during surgery and for patients with metastatic non-small-cell lung cancers. As well as this, immunotherapy can be used following radiotherapy for locally advanced tumours, and some trials have also been studying whether immunotherapy is useful following stereotactic radiotherapy for patients with early lung cancers. For a different type of lung cancer, called a small-cell lung cancer, immunotherapy can now also be used in the metastatic setting.

For other types of cancers, immunotherapy is also used, but it depends on the individual tumour type.

There are some patients who cannot receive an immunotherapy treatment because they have another medical treatment that means it would potentially be dangerous to receive this. Examples of this include inflammatory bowel disease or certain types of lung fibrosis.

For non-small-cell lung cancer where the patient has stage IV or metastatic lung cancer, the aim of using immunotherapy in this circumstance is to keep the cancer controlled for as long as possible.

However, there are some patients with cancers that are treated very effectively with immunotherapy, and approximately 10 to 20 per cent of patients who have immunotherapy for their lung cancer are still alive many years after starting this treatment, with their disease under control. This is a significant improvement compared to chemotherapy, which would prolong the lives of patients for a number of months rather than years.

Dr Crispin Hiley is a highly renowned consultant clinical oncologist and associate professor with over 15 years’ experience who specialises in all the different types of lung cancer, as well as cancer immunotherapy and chemotherapy. He is the Clinical Director for Lung Cancer for GenesisCare in the UK.

If you require immunotherapy treatment for lung cancer, do not hesitate to book an appointment with Dr Hiley via his Top Doctors profile today.