Immunotherapy in bronchial cancer

In some cancers, the immune system is not able to recognize the cancer cell as foreign. One of the mechanisms underlying is a direct negative interaction between white blood cells, called T cells, and the tumor cell, or the cells in our body responsible for presenting tumor antigens to the T cells through checkpoints. Results currently achieved by immunotherapy in lung cancer are mainly obtained in the so-called non-small cell forms, by inhibiting the PD-1/PD-L1 checkpoints. The treatments consist in injecting monoclonal antibodies targeting either PD-1, such as nivolumab and pembrolizumab, or PD-L1, like atezolizumab, durvalumav, and avelumab. This list is not exhaustive. They trigger a reactivation of the patient's immune system against cancer and can thereby induce a memory immune response.

Illustration here

Immunotherapy is a relatively recent therapeutic option in Belgium. It began to be used in 2015, first in the second-line treatment of non-small cell lung cancers and then in 2018 in the first-line treatment of these cancers, alone or in combination with chemotherapy. It will be approved in small cell lung cancer as a first-line treatment with chemotherapy in the near future, and then, as an adjuvant treatment of cancers after concomitant chemo-radiotherapy.

Immunotherapy treatments are implemented on an outpatient basis if prescribed alone. They are administered intravenously every 2 to 3 weeks over a period of several hours. They require hospitalization depending on the type of associated chemotherapy.

The duration of immunotherapy depends on the treatment line. If it is as a second-line treatment, for instance for metastatic cancers, recovery can be obtained and discontinuation of immunotherapy can then be considered. In first-line treatment, the duration of treatment is generally defined in time, especially in the adjuvant setting.

Immunotherapy can induce immune adverse effects. These are inflammatory phenomena that can affect various organs. This can manifest by symptoms felt by the patient. He or she is therefore invited to report any change in his condition as fast as possible. However, it can also manifest as biological disorders without symptoms, which is why a blood test will be taken before each administration. Patients who suffer from an active or dormant autoimmune disease must disclose it to the medical team before the indication for oncological immunotherapy is made.

The treatment is administered preferably at the Ambulatory Treatment Center (ATC) within 90 minutes, after ensuring that there were no adverse effects from previous administration.

After the intravenous infusion, the patient can go home. There are no immediate adverse effects to worry about. Immune adverse effects may occur even after several months of treatment interruption.

Immunotherapy is much better tolerated than chemotherapy, but it is usually much longer. Immune effects usually occur early (within 2–3 months) but they can sometimes appear later, or even after the treatment has been stopped.

Various immune diseases can occur, which is why biological and clinical follow-up is necessary.

Transplanted patients cannot be candidates for this type of treatment. Caution is advised for patients who have or have had an autoimmune disease.

Pour toute information complémentaire ou demande de rendez-vous, vous pouvez prendre contact avec les coordinatrices de soins en oncologie thoracique au +32 2 764 28 02