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Immunotherapy is the use of medicines to help a person’s own immune system to recognize and destroy cancer cells more effectively.
An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoint” proteins on immune cells, which act like switches that need to be turned on (or off) to start an immune response. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system.
Drugs that target these checkpoints (called checkpoint inhibitors) can be used to treat some people with small cell lung cancer (SCLC).
Atezolizumab (Tecentriq) and durvalumab (Imfinzi) target PD-L1, a checkpoint protein found on some tumor cells and immune cells. Blocking this protein can help boost the immune response against cancer cells.
These drugs can be used as part of the first treatment for advanced SCLC, along with etoposide and a platinum chemo drug (like carboplatin or cisplatin). Either drug can then be continued alone as maintenance therapy after the chemo is done.
These drugs are given as an intravenous (IV) infusion, typically every 2, 3, or 4 weeks. Atezolizumab can also be given (as Tecentriq Hybreza) as an injection under the skin (subcutaneously) over several minutes, typically once every 3 weeks.
Side effects of these drugs can include:
Other, more serious side effects occur less often:
Infusion reactions: Some people might have an infusion reaction while getting these drugs. This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, feeling dizzy, wheezing, and trouble breathing. It’s important to tell your doctor or nurse right away if you have any of these symptoms while getting these drugs.
Autoimmune reactions: These drugs remove one of the safeguards on the body's immune system. Sometimes the immune system responds by attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs.
It’s very important to report any new side effects to someone on your cancer care team as soon as possible. If serious side effects do occur, treatment may need to be stopped and you might be given high doses of corticosteroids to suppress your immune system.
Tarlatamab (Imdelltra) is a type of immunotherapy know as a bispecific T-cell engager (BiTE). Once it’s injected into the body, one part of the drug attaches to immune cells called T cells, while another part attaches to the DLL3 protein on SCLC cells. This brings the two together, which helps the immune system attack the cancer cells.
Tarlatamab can be used to treat advanced (extensive-stage) SCLC that is no longer being helped by chemo that included a platinum drug (such as cisplatin or carboplatin).
This drug is given as an IV infusion, typically once a week at first, and then once every 2 weeks. Because of the risk of serious side effects such as cytokine release syndrome (CRS) and nervous system problems (see below), your doctor will want to watch you closely in a healthcare setting for about 24 hours after the first 2 infusions, and for at least several hours after later treatments.
Common side effects of tarlatamab include:
Tarlatamab can also cause more serious side effects:
Cytokine release syndrome (CRS): This is a serious side effect that can occur when T cells in the body release chemicals (cytokines) that ramp up the immune system. This happens most often within the first day after the infusion, and it can be life-threatening. Symptoms can include:
Your health care team will watch you closely for possible signs of CRS, especially during and after the first few infusions. Be sure to contact your health care team right away if you have any symptoms that might be from CRS.
Nervous system problems: This drug can affect the nervous system, which could lead to serious or even life-threatening side effects that can occur days to weeks after treatment. Symptoms can include:
Serious infections: Some people might get a serious infection while getting this drug. Tell your cancer care team right away if you have a fever, cough, chest pain, shortness of breath, sore throat, rash, or pain when urinating.
Low blood cell counts: This drug might lower your blood cell counts, which can increase your risk of infections or bleeding and may make you feel tired or short of breath. Your doctor will check your blood cell counts regularly during your treatment.
Liver problems: This drug can affect your liver, which might show up on lab tests. It might also cause symptoms such as feeling tired, loss of appetite, pain in the upper right part of your belly, dark colored urine, or yellowing of your skin or the white parts of your eyes (jaundice).
To learn more about how drugs that work on the immune system are used to treat cancer, see Cancer Immunotherapy.
To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.
The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.
Horn L, Mansfield AS, Szczęsna A, Havel L, Krzakowski M, Hochmair MJ et al. First-Line Atezolizumab plus Chemotherapy in Extensive-Stage Small-Cell Lung Cancer. N Engl J Med. 2018 Dec 6;379(23):2220-2229.
National Cancer Institute. Physician Data Query (PDQ). Health Professional Version. Small Cell Lung Cancer Treatment. 2023. Accessed at https://www.cancer.gov/types/lung/hp/small-cell-lung-treatment-pdq on Jan 24, 2024.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Small Cell Lung Cancer. V.2.2024. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/sclc.pdf on Jan 24, 2024.
Ott PA, Elez E, Hiret S, Kim DW, Morosky A, Saraf S et al. Pembrolizumab in Patients With Extensive-Stage Small-Cell Lung Cancer: Results From the Phase Ib KEYNOTE-028 Study. J Clin Oncol. 2017 Dec 1;35(34):3823-3829.
Paz-Ares L, Dvorkin M, Chen Y, Reinmuth N, Hotta K, Trukhin D, et al. Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet. 2019;394(10212):1929-1939. doi: 10.1016/S0140-6736(19)32222-6. Epub 2019 Oct 4.
Petty WJ, Paz-Ares L. Emerging Strategies for the Treatment of Small Cell Lung Cancer: A Review. JAMA Oncol. 2023 Mar 1;9(3):419-429. doi: 10.1001/jamaoncol.2022.5631. PMID: 36520421.
Last Revised: September 23, 2024
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