The first-line treatment for extensive stage small cell lung cancer (SCLC) is combination chemotherapy. The initial response rate for this kind of cancer is good, but the relapse rate is very high — generally occurring within a few months.

Other types of cancer have been treated with various immunotherapies for some time. It’s only within the last few years that doctors have been able to use immunotherapy to treat SCLC.

It’s easy to feel stressed when presented with treatment options for your cancer. Learning a bit more about immunotherapy, how it works, and what you can expect will probably help you feel more confident going forward.

In this discussion guide, we’ll provide some questions to help you start this important conversation with your doctor.

It’s the immune system’s job to destroy dangerous cells without harming healthy cells. Cancer cells have stealth abilities. They learn how to use the immune system’s checkpoints to evade detection. Immunotherapy is a treatment that helps your immune system recognize and attack cancer cells.

Drugs that target these checkpoints are called immune checkpoint inhibitors. Some immunotherapy drugs used to treat advanced stage SCLC include:

  • atezolizumab (Tecentriq)
  • nivolumab (Opdivo)
  • pembrolizumab (Keytruda)

Your doctor can provide more information about how each of these drugs works and which option might be best for you.

It’s important to understand the goal of each treatment before making a choice. Is it to slow disease progression? Or is it the goal to relieve symptoms and improve your quality of life? Before you start on a treatment, you want to make sure your goals and your doctor’s goals are the same.

Ask why they recommend — or don’t recommend — immunotherapy for you. Time may be a crucial factor, so find out how quickly you need to make this decision.

You can expect side effects from just about any type of cancer treatment. Some common side effects, like fatigue, nausea, and decreased appetite, are mild and tolerable. But others are serious and can negatively impact your quality of life.

Your doctor can’t predict which side effects you’ll get and the degree of severity, but they can give you a general idea of what to expect.

Here are some questions to ask:

  • What are the typical side effects of this treatment?
  • What are the most dangerous side effects? What warning signs should I be aware of?
  • Can some of these side effects be managed? How?
  • Will I be able to continue with my normal daily activities?

When you’re in treatment for extensive stage SCLC, it’s important to have confidence in your healthcare team. Your doctor should be able to give you some background on their previous experience in this area.

If you have concerns, don’t hesitate to get a second opinion. A good oncologist will understand that you want to be certain before starting a new therapy.

You’ll want to know if there are certain foods, activities, or other medications that can interfere with immunotherapy. Tell your doctor about:

  • your use of vitamins or other dietary supplements
  • any prescription and over-the-counter (OTC) medications you take
  • treatment you’re getting from other doctors
  • the amount of physical activity you usually get
  • if you have sleep problems
  • any other diagnosed medical conditions

Each case is different. You can get immunotherapy along with combination chemotherapy, alone, or after you’ve finished with chemotherapy. You may also be interested in supportive care for specific symptoms.

Immunotherapy is given via intravenous (IV) infusion. You’ll want to know more about the logistics of treatment.

  • How long does a single treatment take?
  • Where do I need to go to get the infusion?
  • How often will I need an infusion?
  • Is there anything I need to do to prepare for starting the treatment or before each treatment?

It can be hard to gauge how well treatment is working based on how you feel or look. Your doctor may want to do periodic physical exams, imaging tests, or blood tests. Ask:

  • What follow-up tests will I need? How often?
  • What will test results tell us?
  • How effective is immunotherapy in treating extensive stage SCLC?
  • What will we do if immunotherapy isn’t working?

Oncologists understand that you have questions and concerns about your cancer treatment. They will set aside time for this discussion. To get the most out of your appointment, bring a list of questions so you won’t forget any. You may also want to bring someone with you to take notes and serve as a backup if you can’t remember something.

If you do forget something, it’s fine to call your doctor’s office between appointments. Oncology practices generally have nurses or staff available to get the answers you need.