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Immunotherapy for the Treatment of Melanoma and Lung Cancer

The lung cancer-related mortality rate exceeds deaths caused by colorectal, prostate, and breast cancer combined. Lung cancer is the second leading most common cancer in women and men. Melanoma is the 6th most common cancer in women and 5th in men. Metastatic melanoma patients survived a maximum of 6 months before the approval of immunotherapy.

Immunotherapy is a cancer treatment that changes the immune system to fight cancer. In the last decade, the treatment has improved oncology care for specific types of cancers. The drug can be administered as a doublet therapy, monotherapy, or in combination with chemotherapy.

Immunotherapy has been approved for the treatment of lung and melanoma cancers. Patients at an advanced stage of melanoma and lung cancer are now experiencing longer survival rates due to immunotherapy.

Types of immunotherapy drugs include:

  • Oncolytic viruses (T-VEC)
  • Adoptive cellular therapies like CAR-T
  • Immune checkpoint inhibitors, specifically, inhibitors of PD-L1, CTLA-4, and PD-1
  • Non-specific immune stimulation like Interferon and BCG

Each drug has unique mechanisms of action, subsequent (irAEs) immune-related adverse effects, and distinctive characteristics. The irAEs occur in 20% of patients getting a combination of immunotherapies and 10% of single-agent immunotherapy patients. Pillars for managing immunotherapy are:

  1. Prevent – evaluating the autoimmune risk factors
  2. Detect – monitoring and reporting to the physician regularly
  3. Monitor complications and responses
  4. Anticipate – assessing for irAEs
  5. Toxicity treatment

In the case of grade 1 irAEs, continue the treatment but monitor the patient closely. For grade 2, pause immunotherapy, check other etiologies, and give corticosteroids. For grades 3 and 4, stop the treatment permanently, check other etiologies, and give corticosteroids. Stop the corticosteroids slowly. 

Unfortunately, immunotherapy drugs are expensive, have a high risk of life-threatening irAEs, and they have a slower onset compared to traditional chemotherapy. The treatment is limited to specific types of cancer.

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