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    IMMUNOTHERAPY IN LUNG CANCER- THE FUTURE OF CANCER CARE. Any cancer and lung cancer in particular creates a highly immunosuppressive environment locally i.e. our bodies immune cells are unable to recognize cancer cells. This is made possible by expression of certain proteins on surface of cancer cells which in turn binds to checkpoints like CTLA-4 and PD-1 present on surface of T-cells . This binding triggers a negative signal and stops T-cells from killing cancer cells. Immunotherapy drugs blocks the CTLA-4 and PD-1 which are checkpoints on T-cells , alternatively other drugs bind to the ligands present on surface of tumor cells. This leads to reactivation of the bodies ability to kill these cancer cells. Pembrolizumab is a immunotherapy drug that is a PD-1 inhibitor and it is approved in both 1st and 2nd line metastatic non small cell lung cancer. There is a IHC test that has to be done with a approved antibody for detecting the expression of PD-L1 ligand in tumor tissue. In the 1st line pembrolizumab is used in patients when PD-L1 expression is more then 50%.In the 2nd line the drug is used when expression >1%. The drug recently got its approval in 1st line in combination with chemotherapy based on the results of one of KEYNOTE trial. Nivolumab is approved in 2nd line irrespective of the PD-L1 expression for metastatic NSCLC. Immunotherapy drugs leads to long term stabilization of metastatic disease in approximately 20% of patients. Cost is a major limitation which restricts its use in developing country
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