ENImmunotherapy for lung cancer in Germany is part of standard care, but not for everyone: tissue tests, cancer type and stage decide. Families ask about it when a relative has metastatic lung cancer, chemotherapy at home is hard to bear or failing, and they read that Germany has long used immunotherapy widely.
Immunotherapy means drugs that help the body’s own immune system recognise the tumour. Below: who it suits, its use in non-small cell and small cell cancer, what changes at stage 3, side effects and what is actually known about vaccines. Other methods: see lung cancer treatment in Germany.
How immunotherapy works and who it suits
Immunotherapy releases a brake the tumour uses to switch off immune cells and suits patients whose tissue tests favour it. Some tumours make much PD-L1, a protein that binds PD-1 on immune cells and halts their attack; CTLA-4 is a similar brake. Checkpoint inhibitors block these brakes. Only some patients respond, and this cannot be predicted reliably.
The tumour tissue is first tested for PD-L1 and for driver changes that fuel growth, such as EGFR mutations or ALK rearrangements. If one is found, treatment usually starts with targeted therapy, mostly tablets, not immunotherapy. Fresh or stored tissue, such as paraffin blocks, is needed (see lung cancer diagnostics).
Side effects differ from chemotherapy: the released immune system can inflame healthy organs such as the bowel, lungs, liver, thyroid or skin. Report diarrhoea, a new cough or breathlessness to the doctor at once: it may be the first sign of inflammation. Marked reactions mean pausing treatment and giving corticosteroids, anti-inflammatory hormones.
Immunotherapy for non-small cell lung cancer in Germany
Non-small cell lung cancer is the most common type; once it has spread, immunotherapy is given alone when PD-L1 is high or with chemotherapy. It is infused into a vein every few weeks, some drugs also as an injection under the skin, usually without a hospital stay. The oncologist chooses the regimen and its length.
Response is checked with CT scans at set intervals. Early on, a tumour may look larger without growing, because immune cells enter it and cause inflammation, known as pseudoprogression. So one scan proves nothing; an experienced immunotherapy team judges the results.
It is given at lung and cancer centres. One specialist is Dr Radu Braga, chief physician of the Department of Pulmonology and the lung centre at Helios Klinikum München West. His department’s focus includes lung tumours; he holds an additional qualification in drug-based tumour therapy and previously coordinated the certified lung cancer centre at the lung clinic in Löwenstein.
Immunotherapy for stage 3 lung cancer in Germany
At stage 3, immunotherapy is used differently than with metastases: if the tumour cannot be removed, maintenance immunotherapy follows concurrent chemoradiotherapy. Maintenance means continuing the drug for a limited time after the main treatment to delay progression. It is offered if the disease has not progressed, the tumour cells carry PD-L1 and there is no typical EGFR mutation; with one, a targeted drug is used.
If the tumour is operable, the tumour board may propose immunotherapy with chemotherapy before surgery, continued afterwards, or only after surgery and chemotherapy, provided there are no EGFR or ALK alterations. A thoracic surgeon operates, for example at the Department of Thoracic Surgery of Agaplesion Frankfurter Diakonie Kliniken in Frankfurt, headed by chief physician Stephan Trainer and part of a lung cancer centre certified by the German Cancer Society. Treatment follows the current German S3 guideline on lung cancer.
Immunotherapy for small cell lung cancer in Germany
In small cell lung cancer, immunotherapy is added to the first chemotherapy once the disease has spread, then continued as maintenance. This cancer grows fast, spreads early and is usually found at an extensive stage. Maintenance is usually one immunotherapy drug; after one regimen, the updated German guideline advises adding another anticancer drug.
Honestly, immunotherapy prolonged life in trials, but it holds the disease back for long only in some patients, and general condition counts. At limited stage, without distant metastases, treatment rests on chemotherapy and radiotherapy, sometimes surgery early on; if the disease has not progressed after chemoradiotherapy, the guideline provides for maintenance immunotherapy approved in the EU, decided by the tumour board.
What is actually known about cancer vaccines
No lung cancer vaccine is approved for routine treatment: cancer vaccines, including mRNA-based ones, are studied in clinical trials with strict entry criteria. Flu and pneumococcal vaccinations are different: STIKO, Germany’s vaccination committee, recommends them for groups including people with chronic lung disease or weakened immunity, for example from chemotherapy; timing is agreed with the oncologist.
Be wary of paid “vaccines” and cell-based methods such as dendritic cells offered outside trials: sound scientific data on their benefits and risks are often missing. Vaccines under study are described on the lung cancer vaccine page.
Frequently asked questions
Does immunotherapy work for every lung cancer patient?
No: only some patients respond. PD-L1 levels help estimate the chances without giving certainty: some patients with low levels benefit, and not all with high levels do. CT scans check the effect regularly, and if the disease progresses or side effects are too severe, the tumour board proposes another treatment.
How long does immunotherapy for lung cancer last?
It depends on the aim: maintenance after chemoradiotherapy and treatment around surgery have a limit set by the regimen, while for metastases the drug usually continues while it works and is tolerated. The German guideline has not settled how long to go on once the disease is controlled; the oncologist discusses this with the patient.
Can immunotherapy be given with an autoimmune disease?
Possibly, case by case. For metastatic non-small cell lung cancer, the German guideline allows it if the autoimmune disease is neither life-threatening nor active and general condition is good. Treatment can cause a flare, so close monitoring is needed; tell the oncologist in advance about rheumatoid arthritis, psoriasis or thyroid disease.
How AlenMed arranges lung cancer immunotherapy in Germany
AlenMed translates the documents and submits them to the partner hospital’s tumour board: the pathology report, tissue blocks for PD-L1 and molecular tests, CT or PET-CT discs and chemotherapy records. The board proposes a treatment plan, the hospital a cost estimate.
Immunotherapy takes long, so the infusions given in Germany and the monitoring of side effects between trips are agreed in advance. We arrange the visa invitation, an interpreter and accommodation. The AlenMed office is in Munich; partner hospitals are across Germany.
This material is for reference only and is not an offer; treatment is decided by a doctor in person.
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