Immune therapy key to extending lung cancer patients' lives

Lung cancer patients were give two rounds of nivolumab before surgery

Lung cancer patients were give two rounds of nivolumab before surgery Credit Lung Cancer

"Non-small cell lung cancer is actually the leading cause of cancer death in the world even though it's not the most common cancer", said Dr. Leena Gandhi, lead investigator of the study and director of the thoracic medical oncology program at Perlmutter Cancer Center at NYU Langone Health.

The findings represent another step forward for immunotherapy, which has been making steady gains against a number of different cancers.

Keytruda, Yervoy and Opdivo are called checkpoint inhibitors.

According to the researchers, the patients' immune systems also likely destroyed straggler tumor cells still circulating in the blood system, which can later take hold and lead to recurrence and metastasis. The most common side effects experienced by both groups were nausea, anemia and fatigue. A year and a half after treatment, the disease had returned in three-quarters of patients with the new treatment. A physician and researcher from the Moffitt Cancer Center in Tampa, Dr. Jhanelle Gray was involved and is an author of the study. "A matter of months, not years", she said. Worldwide, lung cancer causes 1.69 million deaths annually. In the United States, it is expected to kill more than 154,000 people in 2018.

The drug called Keytruda, or pembrolizumab, is already prescribed to a group of patients who have a type of malignancy called non-small cell lung cancer.

Pembrolizumab, sold under the brand name Keytruda, is an FDA-approved drug sold by a subsidiary of Merck & Company, Inc. that sponsored this study. The chemotherapy was a drug called pemetrexed, plus either carboplatin or cisplatin.

But the benefits for Opdivo and Yervoy lasted less than two months on average. The data from this study were simultaneously published online April 16 in the New England Journal of Medicine. "I only treat lung cancer and I've been doing that for about 20 years".

"If you want to see long-term survival, youve got to give immunotherapy as soon as possible", Herbst said. And it suggests that it's fruitful to combine immunotherapy treatment with chemotherapy. He expects they will lead to broader use of immunotherapy combined with chemotherapy for this type of lung cancer. "We have patients on these immunotherapies alive more than eight years".

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. While that's a notable difference, the drug did not stop cancer entirely in most patients.

One group of 400 patients received standard chemotherapy and the immunotherapy drug pembrolizumab, while a smaller group of patients received chemotherapy. Herbst compares it with inflammation around a cut, which marshals the immune system into action, only in this case the wound being targeted is debris from dead cancer cells. 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.

Side effects were nearly universal - 99.8 percent of patients who received Keytruda and chemotherapy experienced them. Median survival is met when 50% of the patients die. 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 risk of severe side effects was similar in both groups (67.2% in the combination group and 65.8% in the standard treatment group), although there was an increased risk of acute kidney injury with the combination treatment (5.2% vs. 0.5%).

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