Can chemo and immunotherapy improve my father’s lung cancer?

Question

Hello doctor,

My father is 50 and recently started treatment for stage 4 lung cancer, and the oncologist recommended both chemotherapy and immunotherapy together from the beginning. We were earlier told that chemo alone is standard, so now we are trying to understand

Can immunotherapy and chemo together beat stage 4 lung cancer at 50?
Is combination therapy given to improve survival or mainly to shrink tumors faster?
Are there specific markers like PD-L1 that decide this treatment plan?
Also, does combination treatment have significantly more side effects than chemo alone?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

In stage 4 lung cancer, the disease has already spread beyond the lung, so treatment is aimed at controlling the cancer, prolonging life, and maintaining a good quality of life.

In recent years, treatment for advanced lung cancer has improved a lot, and many oncologists now start chemotherapy (a systemic cancer treatment using powerful drugs to kill or slow the growth of rapidly dividing cancer cells throughout the body) together with immunotherapy (a cancer treatment that boosts or restores the body’s natural immune system to recognize, target, and eliminate cancer cells) in the first line itself. The reason is that both treatments work in different ways.

Chemotherapy directly damages and kills rapidly dividing cancer cells, while immunotherapy helps the body’s immune system recognize and attack cancer cells. When given together, they can complement each other and improve outcomes in many patients.

So the combination is not given only to shrink tumors faster. One of the main reasons doctors recommend this combination is that large international studies have shown it can improve overall survival compared with chemotherapy alone in many patients with advanced lung cancer. In some patients, the tumors also respond better and remain controlled for a longer period.

Yes, certain markers are important in deciding this treatment plan. One of the key markers is PD-L1 expression (programmed death-ligand 1) on the tumor cells. If PD-L1 levels are very high, sometimes immunotherapy alone may be considered. If PD-L1 levels are low or intermediate, doctors often combine chemotherapy with immunotherapy because the combination tends to work better in that situation.

Before starting treatment, oncologists also usually check for genetic mutations such as EGFR (estimated glomerular filtration rate), ALK (anaplastic lymphoma kinase), ROS1 (c-ros oncogene 1), and a few others, because if those mutations are present, targeted therapy may be more appropriate than chemo-immunotherapy.

Regarding side effects, the combination can have slightly more side effects than chemotherapy alone, but most patients tolerate it reasonably well with proper monitoring. Chemotherapy may cause fatigue, nausea, hair loss, or low blood counts. Immunotherapy works differently and can sometimes cause immune-related inflammation in organs such as the thyroid, skin, lungs, or liver, but this does not happen in most patients and is usually manageable if detected early.

In my clinical experience, many patients around your father’s age can safely take this combination treatment when closely supervised by the oncology team.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.