After your care team completes an initial biopsy and biomarker testing on your non-small cell lung cancer (NSCLC) tumor, they will determine the most effective treatment options for you based on the pathology of your tumor, the stage of your cancer, and your overall health. Comprehensive biomarker testing should illustrate if your tumor has any known mutations and help your oncology team determine how to move forward.
While all lung cancer treatment options have potential benefits, risks, and side effects, it’s important you discuss your options with your care team and feel empowered to be part of that decision-making process.
Immunotherapy
Your care team might recommend immunotherapy, or immuno-oncology based on the type and stage of the tumor, the presence of biomarkers, and/or the PD-L1 status of the tumor. PD-L1 status is a measure of the protein PD-L1 on cancer cells; patients with higher tumor PD-L1 levels may benefit from immunotherapy.
During immunotherapy treatment, drugs are given through an IV infusion every few weeks, much like chemotherapy treatment. In this case, the medicine is using your body’s immune system to help fight the cancer, rather than using the drugs to kill or damage the cancerous cells, where there’s the risk of affecting healthy cells as well.
Immune checkpoint inhibitors, the class of immunotherapy drugs currently used for NSCLC, interfere with the interaction between the body’s immune system and cancer cells to help your immune cells recognize and attack the cancer.
Immunotherapy drugs currently used for NSCLC include:
- Atezolizumab (Tecentriq)
- Cemiplimab (Libtayo)
- Durvalumab (Imfinzi)
- Ipilimumab (Yervoy)
- Nivolumab (Opdivos)
- Pembrolizumab (Keytruda)
- Tremelimumab (Imjudo)
These drugs can be used alone, in combination, or in combination with chemotherapy drugs, depending on where you are in your cancer journey. Common side effects of immunotherapy include fatigue, coughing, shortness of breath, rash, nausea, loss of appetite, diarrhea, and muscle and bone pain. Importantly, the treatment can also cause inflammation throughout your body, so make sure you talk to your doctor to make sure this treatment option is the right one for you.
Targeted Therapy
Targeted drug therapy can be used to attack the tumor directly using drugs that differ from chemotherapy treatment. With targeted therapy, the drugs typically hone in on cancer cells with specific mutations so they can stop tumor growth and kill the cancer cells, while reducing the risk of harming normal healthy cells. Biomarker testing of the tumor will determine if it has any mutations that may be helped by targeted therapy.
There are now FDA-approved targeted therapy drugs used to target several mutations found in NSCLC tumors:
- EGFR: there are four types of EGFR mutations that can be treated with different targeted drugs.
- KRAS: While there are many KRAS mutations found in NSCLC, the KRAS G12C mutation can be treated with FDA-approved drugs (e.g. sotorasib/Lumakras).
- ALK (anaplastic lymphoma kinase): there are several drugs that specifically target tumors with a gene rearrangement or fusion of ALK (e.g. alectinib/Alecensa).
- ROS-1: errors in this gene can be evaluated as a biomarker for NSCLC.
- NTRK: a rare gene fusion that causes cancerous cell growth
- MET: part of the MET gene may be removed or “skipped” to cause cancer
- RET: the RET gene can be rearranged, leading to uncontrolled cell growth
- BRAF: the BRAF V600E mutation can lead to uncontrolled cell growth
As noted above, there are several FDA-approved drugs used to treat these types of cancer. Each works differently to target or stop cells from growing and each has the potential to cause different side effects. Speaking to your care team about the risks and benefits as well as side effects will be vital during your treatment therapy, so don’t be afraid to ask questions and share how you’re feeling.
Common side effects can range from rash, itching, headaches, nausea, and fatigue to more serious side effects like bleeding, problems with other organs, or even additional squamous cell skin cancer growth. To easily track how you’re feeling, try the symptom-tracking feature in the Outcomes4Me app.
If you have any questions about either immunotherapy or targeted therapy, or you’d like to discuss additional treatment options, you can connect with an Outcomes4Me oncology nurse practitioner at no charge through the Outcomes4Me app, using the “Ask Outcomes4Me” button.
