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Revving Up the Immune System to Fight Lung Cancer

How immunotherapy is giving people fighting lung cancer more reasons to hope

By Katie Ressler

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Like many people who have been diagnosed with lung cancer, Jodi Russel had no trouble breathing and no pain. She didn’t know that lung cancer was growing in her body until she was on vacation in Alaska and began to cough up blood.

“That made me think I better get go to the doctor. I even went to Florida before the diagnosis; I was feeling fine. When I was finally diagnosed in August 2016, the tumor was the size of a baby’s head!” Russel recalls.

A persistent cough, hoarseness, shortness of breath, feeling tired or weak, ongoing infections such as bronchitis, new onset of wheezing, and chest pain that worsens with deep breaths are early signs of lung cancer that can be overlooked easily because most of these symptoms can be attributed to less serious illnesses, like a cold or flu. Coughing up blood or rust-colored sputum, also a common sign, should always be reported to a doctor.

Conventional therapies including chemotherapy and radiation therapy used to be the only first lines of treatment for patients with lung cancer. Initially, Russel had 30 rounds of radiation, plus chemotherapy, but her cancer continued to progress. That’s when her oncologist, Theodore Pollock, DO, FACOI, Director of Medical Oncology at Cancer Treatment Centers of America® (CTCA), Tulsa, considered another solution: immunotherapy.

What is immunotherapy and how does it work?

While researchers have been examining the immune system for decades as a way to fight cancer, it wasn’t until recently that patients gained access and began to benefit from these types of drugs.

“Immunotherapy empowers the patient’s own immune system to fight his or her cancer,” explains Dr. Pollock.

Immunotherapy for stage 4 lung cancer was first approved by the FDA as a first-line treatment in 2017. This means that it can be a first treatment option for certain patients whose cancer produces a significant amount of specific proteins. Current immunotherapy drugs approved by the FDA for lung cancer work as checkpoint inhibitors. When the normal immune system is working well, it attacks invaders while leaving normal cells alone.  Cancer cells, however, trick the immune system into treating cancer cells like normal ones.

“When immunotherapy works, it generally works for months and even years,” says Dr. Pollock. For many patients fighting lung cancer, these types of drugs offer hope for the future that didn’t exist even just a few years ago.”

Life during immunotherapy

Because immunotherapy works differently than other cancer-fighting drugs, patients may experience milder side effects. Dr. Pollock explains:

Chemotherapy generally works by targeting quickly dividing cells, like a tumor cell. But, chemotherapy doesn’t know the difference between a dividing tumor cell and a dividing healthy hair follicle cell or bone marrow cell, so these cells tend to be affected by chemotherapy along with the tumor cells, and this is where a lot of chemotherapy side effects come from healthy cells trying to divide and being stopped by chemotherapy.

Immunotherapy doesn’t work like that.  Immunotherapy helps the body’s own immune system seek out and block certain pathways on the tumor cell and stop them from growing.  Side effects tend to arise when the immune system gets too ‘revved up’.  We treat these side effects with medications to help calm down the immune system.  This doesn’t happen very often, so the most frequently reported side effect is fatigue.  Fatigue is typically mild, allowing most patients to continue working their full-time jobs if they so choose.

Immunotherapy side effects vary based on the type of drug, the cancer type and the individual patients’ health. Most side effects are mild or moderate in nature. The most common side effects are skin reactions (e.g., skin redness, blistering, and dryness) and flu-like symptoms (e.g., fatigue, fever, chills, weakness, nausea, vomiting, dizziness, body aches, and high or low blood pressure).

For Russel, the side effects of her treatment have been manageable. Throughout treatment, she has continued to work as an elementary physical education teacher. Luckily, her school district has four-day weeks, so she can schedule treatments on the weekday that she has off.

“My goal as I continue with immunotherapy is to continue working and to stay active,” says Russel. “I’m fortunate to be alive and to have benefitted from immunotherapy, and I will keep fighting cancer until I can’t fight anymore.”

Looking to the future

Researchers continue to look to the immune system for new ways to target cancer, trying to identify new therapies to target cancer cells while offering fewer side effects.

“Immunotherapy has opened up a new door for the treatment of cancer,” says Dr. Pollock. “As an oncologist, I’m excited about what’s on the horizon.”

For Russel, the future looks bright, too. She plans to continue teaching and spending as much time as she can loving on and playing with her grandchildren. She and her family recently bought a travel trailer, and she intends to put it to good use exploring new places. First on her list is Colorado over Christmas.

 

No case is typical. You should not expect to experience the same results.

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