Immune therapy key to extending lung cancer patients' lives

Glen Mclaughlin
April 18, 2018

"A new cancer treatment can help some lung cancer tumors "[melt] away", seriously prolonging patients' lives, according to a series of breakthrough studies revealed this week.

Immune-boosting drugs given in conjunction with chemotherapy significantly extended life for people with the most common type of lung cancer, according to clinical trials.

The study results apply only to patients whose lung cancer does not begin in the squamous cells (or surface lung cell layer) and who also lack certain genetic mutations. He said that tumor cells were like bags of hidden proteins that, if exposed, the immune system could use as targets to find and attack cancer.

The differences would likely have been more pronounced, but many patients in the chemotherapy group were given Keytruda or a similar drug once their disease progressed.

There are more than 200,000 new cases of NSCLC each year in the United States alone, with about half at advanced stage at the time of initial diagnosis.

Gandhi's study included 616 patients with advanced lung cancer, ages 34 to 84, from medical centers in 16 countries.

Steve Cara, who learned of his advanced lung cancer in 2014, rides to the Memorial Sloan Kettering Cancer Center in NY in 2016. But those drugs and rival immunotherapies from Roche and AstraZeneca are jockeying for pieces of the largest lung cancer market.

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"Some families in China do not have decent or any ventilators to expel the cooking oil smoke which could lead to lung cancer even if they don't smoke", said Wang Xiujian, a member of the Chinese Anti-Cancer Association (CACA). In patients who received the combination treatment, 48 percent saw their tumors shrink considerably, compared with 19 percent who only received chemotherapy. Data from the study demonstrated that as an adjuvant treatment, Keytruda significantly increased recurrence free survival ("RFS") after surgery compared to placebo in such patients. The studies were sponsored by the drugmakers, and many study leaders and Herbst consult for the companies. Serious side effects were a little more common in the chemo group.

Dr. Matthew Hellman of Memorial Sloan Kettering Cancer Center in NY, who led the study, said it was a validation of TMB as a biomarker and that Opdivo with Yervoy should be an important chemotherapy-sparing regimen in first-line lung cancer.

"We know that chemotherapy is not what people want", Kmiec said.

For patients with PD-L1-low tumors, defined as those with expression between 1% and 50% (n = 140), median PFS was 9.7 months for those assigned atezolizumab and 6.9 months for those assigned the control regimen (HR = 0.57; 95% CI, 0.38-0.84).

The pembrolizumab cohort did not reach median OS, compared to the 11.3 months (95% CI, 8.7-15.1) found in the chemotherapy-alone arm.

Dr. Matthew Hellman of Memorial Sloan Kettering Cancer Center in NY, who led the study, and others said it was a validation of the TMB biomarker. In that group, survival without worsening of disease was 43 percent after one year for those on the immunotherapy drugs versus 13 percent of those on chemo.

Dr. Gomez thinks the survival rate could be as high as double chemotherapy alone, "which would be very impressive", he said. "I only treat lung cancer and I've been doing that for about 20 years". We do need to focus more on how to differentiate the patients who will get the most benefit.

Other reports by MaliBehiribAe

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