You might have immunotherapy or a targeted drug if you have non small cell lung cancer (NSCLC) that has spread just outside the lung (some stage 3 cancers) or to another part of the body (stage 4).
Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells. Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive.
Tests on your cancer cells
Doctors look for certain changes in genes (mutations) in your lung cancer that help it to grow and divide. They look for changes in the:
- epidermal growth factor receptor (EGFR) gene
- the anaplastic lymphoma kinase (ALK) gene
- the ROS1 gene
- the K-RAS gene
They usually test a sample of your lung cancer tissue from when you were first diagnosed. Or from your operation if you had one.
The results of the tests show whether a targeted cancer drug or immunotherapy is suitable for you.
EGFR gene changes
Epidermal growth factor receptor (EGFR) is a protein on the surface of cells that helps the cells to grow and divide. Some cells have a fault in the EGFR gene, causing it to signal to the cancer cells to divide and make more copies (replicate).
EGFR inhibitor drugs can block the signal from EGFR that tells the cells to grow. Blocking the signal from EGFR to the cancer cells can stop them growing.
If your lung cancer has the EGFR gene change (mutation) then you might be offered one of these drugs depending on the stage of your cancer.
- Gefitinib (Iressa)
- Afatinib (Giotrif)
- Erlotinib (Tarceva)
- Dacomitinib (Vizimpro)
- Osimertinib (Tagrisso)
ALK gene changes
About 5 in 100 people (5%) with NSCLC have a change in a gene called anaplastic lymphoma kinase (ALK). This gene change signals to the cancer cell to divide and make more copies of itself.
Drugs that block these signals that the ALK gene change sends include:
- Crizotinib (Xalkori)
- Ceritinib (Zykadia)
- Alectinib (Alcensa)
- Brigatinib (Alunbrig)
ROS1 gene changes
The ROS1 gene change is similar to the ALK gene change. This change means that the cancer receives signals to grow. Some targeted drugs block these signals. Drugs that work on blocking the signals that the ROS1 gene sends include:
- Crizotinib (Xalkori)
- Ceritinib (Zykadia)
K-RAS gene changes
Some lung cancers have changes in a gene called K-RAS. The K-RAS gene is important in controlling cell growth. Changes to this gene can lead to cells growing and dividing out of control to form cancers. Drugs that target a specific type of this gene change include:
- sotorasib (Lumakras)
Other targeted therapy drugs and drugs in development
Nintedanib (Vargatef) is given in combination with the chemotherapy drug docetaxel (Taxotere). You might be given nintedanib if your cancer comes back after your first chemotherapy treatment.
Targeted drugs are constantly in development and being tested in clinical trials. Other drugs that are in development for NSCLC include:
Immunotherapy uses our immune system to fight cancer. It works by helping the immune system recognise and attack cancer cells.
There are several immunotherapy drugs for NSCLC. Researchers are also developing new drugs and testing them in clinical trials. Immunotherapy drugs that your doctor might recommend you have include:
- Pembrolizumab (Keytruda)
- Nivolumab (Opdivo)
- Durvalumab (Imfinzi)
- Atezolizumab (Tecentriq)
Your doctor might recommend you have pembrolizumab if you have advanced NSCLC and your cancer cells have particular proteins. It targets and blocks a protein called PD-1 on the surface of certain immune cells called T-cells. Blocking the PD-1 protein triggers the T-cells to find and kill cancer cells.
You might have nivolumab if you have already had chemotherapy and the cancer has spread outside of your lung into the surrounding tissue (locally advanced), or to other parts of your body (advanced).
You might have durvalumab if you have stage 3 lung cancer that has spread within your lung and can't be removed with surgery, and your cancer either stayed the same size or shrunk when you had chemotherapy and radiotherapy.
You might have treatment with atezolizumab if you've not had treatment before and you have metastatic NSCLC and your cancer cells are PD-L1 positive.
Atezolizumab may also be available for some people who have had surgery and chemotherapy for early stage NSCLC. The atezolizumab helps to reduce the risk of the cancer coming back.
Targeted therapy drugs and immunotherapy drugs can cause different side effects. Some of these can be serious. Your doctor or nurse will talk to you about this. Always tell them about any side effects you have and follow the advice they give you.
Choose a drug on our A to Z list to read about side effects and find out more about the drug.