Treatment combo almost doubles survival time in lung cancer patients, study finds

Henrietta Strickland
April 17, 2018

Another study found that an immunotherapy combo - the Bristol-Myers Squibb drugs Opdivo and Yervoy - worked better than chemo for delaying the time until cancer worsened in advanced lung cancer patients whose tumors have many gene flaws, as almost half do.

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.Of the two types of lung cancer, small cell lung cancer is less common than non-small cell lung cancer, which affects up to 85% of all lung cancer patients.

Lung cancer is the leading cause of cancer death globally, causing 1.7 million fatalities a year.

"What it suggests is that chemotherapy alone is no longer a standard of care", said Dr. Leena Gandhi, a leader of the study and director of the Thoracic Medical Oncology Program at the Perlmutter Cancer Center at New York University Langone Health.

Gandhi explained that the reason non-small cell lung cancer is so deadly is the existing chemotherapy drugs provide only limited survival benefits for patients.

"Ive been treating lung cancer for 25 years now, and Ive never seen such a big paradigm shift as were seeing with immunotherapy", said Dr. Roy Herbst, chief of Medical Oncology at the Yale Cancer Center.

Other companies have similar immunotherapy drugs, but Merck's product has an advantage for treatment of lung cancer because it already has data in hand to show its drug is effective in this setting. A year and a half after treatment, the disease had returned in three-quarters of patients with the new treatment. "And the differences were not small".

Of those treated with pembrolizumab and platinum + pemetrexed, the risk of death was reduced by 51%, compared to those treated with platinum + pemetrexed alone.

But patients in the immunotherapy group had more kidney problems, more immune-related adverse events and were more likely to stop treatment because of side effects. The most common issues in both groups were nausea, anemia and fatigue.

Dr. Jorge Gomez, a volunteer spokesperson for the American Lung Association and a medical oncologist and director of thoracic oncology at Mount Sinai Hospital in NY, explained that "about 220,000 patients are diagnosed with lung cancer a year in the U.S.". They remove a cloak that some cancer cells have that hides them from the immune system.

Herbst said medical researchers didn't immediately think of combining chemotherapy with immunotherapy because it seemed odd to try to use chemicals to kill the cancer cells that the immune system was also supposed to be hunting down. The median overall survival was 11.3 months in those who did not receive immunotherapy, whereas survival in the immunotherapy group was longer and the median has not yet been reached.

The median time until cancer worsened was about 7 months on the immunotherapy drugs versus 5.5 months for chemo.

"It's already been 21 months", said Gomez.

Gomez believes it could be as high as double chemotherapy alone, "which would be very impressive", he said.

The "auto-vaccine" might result in the activation of tumor-specific T cells that would then circulate through the body and find distant sites of micrometastases, thereby preventing relapse post-surgery which can happen to at least one-half of lung cancer patients who undergo surgery. These drugs are very, very interesting.

Keytruda was approved a year ago as an initial treatment with chemo for the most common form of advanced lung cancer, but doctors have been leery to use it because that was based on a small study that did not show whether it prolongs life.

Other reports by Click Lancashire

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