Immunotherapy for Small Cell Lung Cancer

Immunotherapy is the use of medicines to stimulate a person’s own immune system to recognize and destroy cancer cells more effectively.

Immune checkpoint inhibitors

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoints” or proteins on immune cells that need to be turned on (or off) to start an immune response. Cancer cells sometimes use checkpoints to avoid being attacked by the immune system. But drugs that target these checkpoints can be used to treat some people with small cell lung cancer (SCLC).

  • Nivolumab (Opdivo) and pembrolizumab (Keytruda) target PD-1, a protein on T cells (a type of immune cell) that normally helps keep these cells from attacking other cells in the body. By blocking PD-1, these drugs boost the immune response against cancer cells. This can shrink some tumors or slow their growth. They are used to treat advanced SCLC in people whose cancer continues to grow after getting at least two previous treatments, including chemotherapy with either cisplatin or carboplatin.
  • Atezolizumab (Tecentriq) targets PD-L1, a protein related to PD-1 that is found on some tumor cells and immune cells. Blocking this protein can also help boost the immune response against cancer cells. This drug can be used as part of the first-line treatment for advanced SCLC, along with the chemo drugs carboplatin and etoposide, and then continued alone as maintenance therapy.

These drugs are given as an intravenous (IV) infusion, typically every 2, 3 or 4 weeks.

Possible side effects of immunotherapy for SCLC

Side effects of these drugs can include fatigue, cough, nausea, skin rash, decreased appetite, constipation, joint pain, and diarrhea.

Other, more serious side effects occur less often.

Infusion reactions: Some people might have an infusion reaction while getting these drugs. This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing. It’s important to tell your doctor or nurse right away if you have any of these symptoms while getting these drugs.

Autoimmune reactions: These drugs remove one of the safeguards on the body's immune system. Sometimes the immune system responds by attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs.

It’s very important to report any new side effects to someone on your health care team as soon as possible. If serious side effects do occur, treatment may need to be stopped and you might be given high doses of corticosteroids to suppress your immune system.

To learn more about this type of treatment, see Cancer Immunotherapy.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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National Cancer Institute. Physician Data Query (PDQ). Health Professional Version. Small Cell Lung Cancer Treatment. 2019. Accessed at https://www.cancer.gov/types/lung/hp/small-cell-lung-treatment-pdq on June 12, 2019.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Small Cell Lung Cancer. V.1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf on June 12, 2019.

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Last Medical Review: October 1, 2019 Last Revised: October 1, 2019

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