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Immunotherapy and targeted cancer drugs for non small cell lung cancer (NSCLC)

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

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. 

Targeted drugs

EGFR gene changes

Epidermal growth factor (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)

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)

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:

  • Dabrafenib
  • Trametinib
  • Vemurafenib 

Immunotherapy

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)

Pembrolizumab (Keytruda)

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. 

Nivolumab (Opdivo)

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).

Durvalumab (Imfinzi)

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. 

Side effects

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. 

Last reviewed: 
10 Jan 2020
Next review due: 
10 Jan 2023
  • Management of stage 3 non small cell lung cancer (NSCLC)

    S.E Schild and others

    Accessed Jan 2020

  • Dabrafenib and trametinib for the treatment of non-small cell lung cancer.

    R.J Kelly

    Expert review of anticancer therapy, Nov 2018;18 (11):1063-1068.

  • Osimertinib for untreated EGFR mutation-positive non-small-cell lung cancer

    NICE Guidance Jan 2020

  • Lung cancer diagnosis and management
    National Institute for Health and Care Excellence (NICE), updated 2019

  • Electronic Medicines Compendium 

    Accessed Jan 2020