Combination therapy doubles survival in metastatic lung cancer

Tuesday, 17 Apr, 2018

The findings should change medical practice immediately, cancer experts say: Patients with this type of lung cancer should receive an immune-activating drug, also called immunotherapy, as early as possible after the diagnosis is made. It's the biggest win so far for immunotherapy, which has had much of its success until now in less common cancers.

The study estimates that one year after treatment, 69 percent of patients who received the immunotherapy drug in addition to chemotherapy would still be alive, compared with 49 percent of people who received chemotherapy alone.

Combining an immunotherapy drug with chemotherapy almost doubled the survival time of some lung cancer patients compared to patients treated with chemotherapy alone, new research published Monday in the New England Journal of Medicine showed. But the benefit lasted less than two months on average and it's too soon to know if the combo improves overall survival, as Keytruda did.

The therapy turned out to be not only safe but 45 percent of the patients in the initial trial responded so well that there was little evidence of the cancer remaining upon follow-up. "I only treat lung cancer and I've been doing that for about 20 years". He was at the American Association for Cancer Research meeting in Chicago where the results were announced, and was asked to provide commentary afterwards. The studies were sponsored by the drugmakers, and many study leaders and Herbst consult for the companies. And it turns out that Keytruda, in combination with standard chemotherapy, also works in patients even if they have a low score on the blood test, which measures something called the tumor proportion score for PD-L1.

Non-squamous lung cancer patients make up about 80% of all the non-small cell lung cancers, so that amounts to over 150,000 patients in the USA each year, said Gomez, who was not involved in the new study. The drugs are given through IVs and cost about $12,500 a month.

Recalling a patient with advanced lung cancer whose tumor disappeared and has not grown back after finishing treatment 24 months ago, Gomez said, "I'm now becoming much more optimistic that if we can really find a way to flawless this treatment and to really figure out who are the patients who do the best and why that we may be able to do something like get rid of lung cancer for at least some patients".

Side effects were nearly universal - 99.8 percent of patients who received Keytruda and chemotherapy experienced them. "But for patients with NSNSLC without EGFR or ALK alterations, this study may suggest a new standard of care". And among those in the comparison group, who got a placebo and chemotherapy, 99 percent reported side effects. More than 4 percent of that group developed lung inflammation and three patients died of it.

In another study, the combination of Bristol-Myers Squibb's Opdivo and Yervoy worked better than chemo alone for delaying the time until cancer worsened in advanced lung cancer patients whose tumors have many gene flaws, as almost half do, AP reported. Medicare recently agreed to cover the $3,000 test for advanced cancers.

One group of 400 patients received standard chemotherapy and the immunotherapy drug pembrolizumab, while a smaller group of patients received chemotherapy. By killing some tumor cells, chemotherapy could pop open the bags, release the contents and help immune cells — unleashed by the checkpoint drugs — to identify their prey. "Now, not everybody benefits unfortunately, but some of the people who benefit seem to benefit in a way we've never seen". Yet, median survival among the study participants who received both immunotherapy and chemo has not yet been reached.