Immunotherapy in lung cancer

Lung Cancer

Cancer is a condition in which the cells grow uncontrollably beyond the normal levels. When this occurs in lung (lung cells), it is called as Lung cancer. Lung cancer is basically of two main types: non-small cell lung cancer (NSCLC) and small cell lung cancer. The nature of growth and the treatment strategy both are different for these types of lung cancers. Among both the types, non-small cell lung cancer is more common. Apart from these types, there are other types of lung cancer as well but less common.

Risk Factors

Risk factors of lung cancer can be many such as:

• Tobacco use: Tobacco, smoked or smokeless, is harmful in any form. Topmost are cigarette and beedi smoking but non-smokers can also develop lung cancer. Not only lung but tobacco use increases the risk of cancer of other regions as well such as lip, oral cavity, pharynx, head, and neck region, digestive, respiratory and intrathoracic organs including liver, pancreas, colon, rectum, bladder, kidney, cervix, blood, etc.

In India,
87% of male patients and 85% of female patients have had history of active tobacco smoking exposure, whereas 3% of patients had passive tobacco exposure (indirect exposure of inhalation of smoke due to being in the vicinity of smokers).

• Occupational exposure to toxins: Exposure to chemicals or toxic substances such as asbestos (in mines, mills, textile plants, etc.), radioactive ores such as uranium, inhaled chemicals such as arsenic, beryllium, cadmium, silica, vinyl chloride, nickel compounds, chromium compounds, coal products, mustard gas, and chloromethyl ethers.
• Arsenic in drinking water: Arsenic in drinking water (primarily from wells) can increase the risk of lung cancer.
• Indoor burning of coal: Indoor combustion of coal, for various purposes like cooking, heating, etc. is found to increase the risk of lung cancer. Especially in houses with poor ventilation, coal combustion results in high levels of indoor air pollution and increases the risk further.
• Lung infections: Infections like chlamydia pneumoniae or tuberculosis (TB) that cause scar formation in lung tissue, are found to increase the risk for cancer of the lung. Moreover, studies suggest that people who have had TB have double the risk of lung cancer.
• History of Lung Cancer: Any family or personal history of lung cancer increases the risk of lung cancer. The cancer survivors who have received radiation therapy for other cancer at chest area are also at higher risk.

Statistics and Disease burden of lung cancer in India

GLOBOCAN 2018 observed data revealed that lung cancer accounted for 67,795 new cases (i.e., 5.9%) and 63, 475 death cases (8.1%) out of that by other cancer types in India in the year 2018.

• The mean age for getting lung cancer is 54.6 years with the majority of lung cancer patients being above 65 years of age.
• Gender predilection ratio:
  • More common in males with Male
  • Female ratio of 4.5 Variable with age and smoking status
  • The ratio increases up to 51-60 years and then remains constant.
• Smoker: Non-smoker ratio is up to 20:1

Symptoms of lung cancer

Symptoms of lung cancer differs from individual to individual and depends on the stages of cancer.

While some people may have symptoms related to the lungs others can have specific to sites where cancer has spread (metastasized). The symptoms might range from general symptoms like not feeling well to other specific symptoms. Whereas most of the patients might not even feel any symptoms until they reach to an advanced stage.

Some of the common symptoms maybe –

• Persistent cough worsening with time
• Difficulty breathing or shortness of breath
• Difficulty swallowing
• Wheezing
• Pain in shoulder or chest during breathing, coughing, or laughing
• Blood or traces of blood in phlegm (sputum) while coughing
• Sudden or drastic weight loss without any evident cause
• Long term fatigue or extreme tiredness from long time
• Loss of appetite
• Repeated lung infections like pneumonia
• Changes occurring in fingers and nails (shape, color, etc.)

Treatments available for lung cancer

There are various factors on which the treatment of lung cancer depends:

• Type of lung cancer (small cell or non-small cell)
• Size of the tumor
• Extent of its spread (local or metastatic)
• General condition of the patient

The various treatment modalities available for the treatment of lung cancer are surgery, chemotherapy, radiotherapy or radiation therapy and targeted therapy.

Surgery – Surgery is done to cut out the tumor tissue. If any nearby lymph nodes are affected, the doctor will also remove them surgically. Surgery alone is not often the only treatment; it is mostly given together with chemotherapy or radiation or both. This is to kill or eliminate any residual cancer cells after surgery. The treatment that is given to lower the risk of cancer recurring back is called adjuvant therapy.

Chemotherapy – Chemotherapy is the most important therapeutic modality in case of small cell lung cancer because this cancer spreads or propagates at a faster rate. Depending on the stage and type of lung cancer, chest radiotherapy alone or combined with chemotherapy or chemotherapy alone is decided. The doctor, after detailed investigations and discussions with other specialists, plans and decides the suitable regimen for each patient.

Radiation therapy – Radiation therapy is one of the modalities for cancer treatment that employs high-energy x-rays or radiations to destroy cancer cells or prevent their spread within the body. Radiation therapy can be administered either from outside the body (using external machines towards cancer like external beam radiation) or by using a radioactive substance sealed in needles, seeds or catheters being placed into or near the cancerous area (brachytherapy).

The type and stage of cancer decides the radiation therapy a patient receives. It can be given after surgery to ensure the elimination of any cancer cells left out in surgery or as palliative therapy for symptomatic relief such as pain or other symptoms in advanced stage lung cancer patients.

External radiation therapy is used to treat small cell lung cancer, and may also be used as palliative therapy to relieve symptoms and improve quality of life.

Targeted therapy – Targeted therapies as the name suggests, are the agents or products used in cancer treatment that ‘target’ or aim at specific molecules or substances in the tumor cells. They specifically target and destroy the cancer cells sparing the normal ones, stop growth of cancerous cells and prevent its spread within the body by blocking signals inside the cancer cells.

The major difference between chemotherapy and targeted therapies is that chemotherapy acts on all rapidly dividing cells irrespective of them being cancerous or normal whereas targeted therapy acts only on the specific ‘target’ molecules in/on the cancerous cells sparing the normal cells. Therefore, the adverse effects are minimal or less with targeted therapy.

Lung Cancer immunotherapy or Immunotherapy for lung cancer

What is immunotherapy?

Cancer immunotherapy is a cancer treatment modality that utilises and enhances the ability of body’s immune system or defence system to perceive, target, control, and eliminate cancer cells present within the body. Immunotherapy treatments for preventing, managing, or treating different cancers can also be used in combination with surgery, chemotherapy, radiation, or targeted therapies to improve their effectiveness.

Immunotherapy for lung cancer – Immunotherapy is one of the latest treatment modalities used for the treatment of lung cancer. In India, approval for lung cancer immunotherapy by the Drugs Controller General of India (DCGI) followed soon after the US FDA approval, making it available to the needful cancer patients in whom chemotherapy or other primary cancer treatment are not successful. There are many approved types available for immunotherapy treatment for lung cancer in India. Immunotherapy for small cell lung cancer as well as non-small cell lung cancer immunotherapy is approved and available in India. Lung cancer immunotherapy is one of the assuring therapies and could be an effective weapon in the battle against lung cancer. Among the various available immunotherapy hospitals for lung cancer in India, one of the best hospitals for immunotherapy for lung cancer treatment is available at American Oncology Institute, Hisar with premium cancer care services and a highly-experienced team of doctors.

How does immunotherapy work?

Under normal conditions, the body’s immune or defence system can identify, recognize and destroy the cancer cells inside the body. Even though the immune system is potent to prevent or slow down cancer growth, the cancer cells might develop ways to be spared from destruction by the immune system. Immunotherapy aids the immune system to act in a better way on the cancer cells. Unlike other cancer treatment modalities, immunotherapy uses substances or materials from living organisms to fight cancer. Hence, it could be said that cancer immunotherapy equips the body’s immune system to help fight cancer in a more biological way.

What are the advantages of immunotherapy?

When compared to the traditional treatment modalities for cancer treatment, immunotherapy has many benefits to offer such as:

• Effective in cancer cases that have become non-responsive or resistant to conventional chemotherapy and radiation treatment e.g. melanoma immunotherapy, stage 4 lung cancer treatment immunotherapy.
• Provide better treatment outcomes when combined with the conventional therapies say with chemotherapy or radiation therapy.
• Immunotherapy, being more specific or targeted and biological in nature results in fewer side effects over traditional therapies i.e., chemotherapy or radiotherapy.
• Offers long-lasting ‘immune-memory’ to the defence system to remember cancer cells which results in longer-lasting remissions i.e., the chances of recurrence are less and delayed. Clinical studies also have supported the beneficial and durable responses with immunotherapy for cancer treatment.

What are the side effects of Immunotherapy?

Immunotherapy shows less side effects over the conventional therapies for cancer treatment like chemotherapy and/or radiation therapy. Cancer immunotherapy side effects or Immunotherapy for lung cancer side effects if occur, they are manageable now-a-days due to the availability of advanced treatment options.

Most of the side effects which occur are not that serious and mentioning a few, these can be:

• Infusion reactions: Not all but some patients might have these reactions when receiving immunotherapy. Symptoms can be fever, chills, rashes and/or itching of skin, flushing on face, dizziness, difficulty in breathing, wheezing, etc.
• Auto-immune reactions: These reactions occur mainly due to the immunotherapy affecting other parts of the body. Symptoms can be serious or even life-threatening and involve the lungs, intestines, liver, kidneys, or other organs.
• Mostly immunotherapy side effects are like allergic reactions, but sometimes it could be serious requiring medical attention as well such as inflammation of the gut, lungs, hormonal system problems.

Who can receive immunotherapy?

• Cancer cases non-responsive or refractory to conventional therapies like chemotherapy, radiation therapy or both. For e.g. melanoma immunotherapy, stage 4 lung cancer treatment immunotherapy.
• Cancer patients eligible for combined treatment for lung cancer treatment or any other approved cancer’s treatment for combination therapy of immunotherapy with chemotherapy and/or radiotherapy. For e.g. immunochemotherapy for lung cancer or stage 4 lung cancer treatment chemo-immunotherapy.

Future of immunotherapy for other cancer treatments in India

After decades of studies on the role of immune system in treating cancer in a more biological/natural way, the researchers have had been successful in receiving the US Food and Drug Administration (US FDA) approval for immunotherapy treatment for cancer. Immunotherapy is one of the assuring therapies for cancer treatment to come along. Immunotherapy is now even recommended by many international cancer treatment guidelines. There have been many studies and clinical trials which support the effectiveness of immunotherapy. Not only for lung cancer, but immunotherapy is available for other cancers as well such as melanoma, lymphoma, head and neck cancers, kidney cancer, bladder cancer, etc. Numerous studies are ongoing to evaluate immunotherapy, as single agents or in combination with other therapies.

Even though immunotherapy offers many advantages in cancer treatment, there are a few challenges on its way such as:

• High costs – the high costs of treatments of immunotherapy are one of the limiting factors for patients opting for it. Immunotherapy is one of the most expensive cancer treatments available today.
• Not equal response in all – Even though miraculous improvement in some cases, immunotherapy might not be equally effective for all patients. Few people only show partial response i.e., the tumor might stop growing or spreading but isn’t eliminated from the body.
• Long-term data is still insufficient – Researches are still ongoing to decide which cancer types, stage/setting, where in the treatment cycle and what testing is required. Also, the long-term effects and effectiveness of immunotherapy is not totally known. With more data available in future days, it could become clear.
• Extensive financial support is needed – Research and development for cancer immunotherapy requires extensive funding and government support.

Immunotherapy is a good treatment option in cases non-responsive to traditional chemotherapy and/or radiation therapy for cancer treatment. Although immunotherapy is one of the most expensive cancer treatments available today, it could be economical especially when compared to that in other countries.

Not only for lung cancer, but immunotherapy is available for the treatment of other types of cancers as well in India. Immunotherapy for lung cancer in Hisar is available at American Oncology Institute providing comprehensive cancer care equipped with advanced technologies and extremely experienced team of doctors. Immunotherapy lung cancer cost in Hisar, American Oncology Institute can offer you with treatment solutions for almost every cancer at an economical and affordable way.

To know more about immunotherapy for lung cancer treatment or immunotherapy for other cancers, you can easily reach out to us at American Oncology Institute, Hisar and/or any of our units near your location.

Our cancer specialists and Medical Oncology consultants are always there to serve you better with their consultations and treatments across all our locations.