Immunotherapy has transformed the treatment landscape for lung cancer over the past decade. By harnessing the body’s own immune system, it has improved survival outcomes and quality of life for many patients, including those with advanced disease.
Dr Dionysis Papadatos-Pastos, consultant medical oncologist specialising in thoracic cancers, explains how immunotherapy works, who may benefit from it, and how it is used within the UK healthcare system.
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Topics Covered
Topics CoveredWhat Is Immunotherapy?
Immunotherapy is a type of cancer treatment that enhances the immune system’s ability to recognise and attack cancer cells. Unlike chemotherapy, which directly targets rapidly dividing cells, immunotherapy works by removing the “brakes” that cancer places on immune responses.
In lung cancer, immunotherapy has become a standard part of treatment for many patients, particularly those with non-small cell lung cancer (NSCLC).
How Immunotherapy Works in Lung Cancer
Cancer cells can evade the immune system by exploiting natural immune checkpoints — mechanisms that normally prevent excessive immune activation. Immunotherapy drugs, known as immune checkpoint inhibitors, block these pathways and allow immune cells to recognise and destroy cancer cells.
The most commonly targeted pathways in lung cancer are PD-1 and PD-L1. When these are inhibited, immune cells can mount a more effective anti-cancer response.
Types of Immunotherapy Used in the UK
In the UK, immunotherapy for lung cancer is primarily delivered using immune checkpoint inhibitors. These treatments may be used:
- On their own
- In combination with chemotherapy
- As maintenance therapy
- Following chemoradiotherapy in selected cases
Treatment selection depends on tumour type, stage, biomarker results, and overall patient fitness.
Who Can Benefit from Immunotherapy?
Not all patients with lung cancer are suitable for immunotherapy. Benefit depends on several factors, including tumour biology and overall health.
Immunotherapy is most commonly used in:
- Advanced or metastatic non-small cell lung cancer
- Certain earlier-stage settings before or/and after surgert or following chemoradiotherapy
- Patients whose tumours express immune-related biomarkers
In small cell lung cancer, immunotherapy may also be used in combination with chemotherapy in selected cases.
The Role of Biomarker Testing
Before starting immunotherapy, tumour tissue is usually tested for biomarkers that help predict response. The most important of these is PD-L1 expression.
Higher PD-L1 levels are associated with a greater likelihood of response, although patients with low or absent PD-L1 expression may still benefit in combination treatment settings.
Molecular testing for genetic alterations (such as EGFR or ALK) is also essential, as patients with certain mutations may respond better to targeted therapies rather than immunotherapy.
Benefits and Limitations
For some patients, immunotherapy can lead to durable disease control and long-term survival. Responses may be sustained even after treatment has stopped.
However, immunotherapy does not work for everyone. Some cancers are less immunogenic, and others may develop resistance over time. Ongoing research aims to better identify which patients are most likely to benefit.
Side Effects and Safety Considerations
Immunotherapy is generally better tolerated than traditional chemotherapy, but it can cause immune-related side effects. These occur when the immune system becomes overactive and may affect organs such as:
- Skin
- Lungs
- Thyroid
- Liver
- Gastrointestinal tract
Early recognition and management of side effects is essential and allows most patients to continue treatment safely.
Access to Immunotherapy in the UK
In the UK, immunotherapy for lung cancer is available for patients who meet specific clinical criteria. Treatment decisions are made within multidisciplinary cancer teams, ensuring evidence-based and individualised care.
Private treatment options may also be available in certain circumstances.
Support and Follow-Up Care
Dr Papadatos-Pastos and his team provide ongoing support beyond medical treatment.
Patients receive clear communication, psychological care and access to nutrition, physiotherapy and symptom-management services.
Regular follow-up ensures early detection of recurrence and long-term wellbeing.
Book a Consultation
If you or someone close to you has been diagnosed with lung cancer, early consultation with a specialist can make a real difference. Appointments are available at several London clinics.
Faq
Answers to Common Questions
The following questions address common concerns patients and families have when immunotherapy is discussed as part of lung cancer treatment.
No. Immunotherapy works by activating the immune system, whereas chemotherapy directly targets rapidly dividing cells. The two treatments have different mechanisms and side-effect profiles.
No. Suitability depends on cancer type, stage, biomarker results, and overall health.
PD-L1 is a protein expressed on cancer cells that helps them evade the immune system. Its presence can help predict response to immunotherapy.
In advanced disease, immunotherapy is not usually considered curative, but it can lead to long-term disease control in some patients.
Most immune-related side effects are reversible if detected early and managed appropriately.
