Immuno-Chemotherapy Combo Extends Lung Cancer Victim's Survival Period

A combination of an immunotherapy drug from Merck and standard chemotherapy led to improved survival for cancer patients

"The data show that treatment with pembrolizumab and chemotherapy together is more effective than chemotherapy alone", said lead investigator Leena Gandhi, director of the thoracic medical oncology program at Perlmutter Cancer Center at NYU Langone Health.

Chicago: For the first time, a treatment that boosts the immune system greatly improved survival in people newly diagnosed with the most common form of lung cancer.

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 new studies suggest that different types of tumors should receive different treatment regimens, all including immune therapy, Hellmann said.

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 United States". The studies simultaneously were published by the New England Journal of Medicine on a day that some experts called the “Super Bowl of lung cancer immunotherapy.”.

But trials over the last five years have repeatedly shown more uses for immune therapy in lung cancer, and the new research confirms that almost all lung cancer patients will now receive immune therapy, said Patrick Forde, the first author on one of the studies and a lung cancer specialist at Johns Hopkins Medical. And among those in the comparison group, who got a placebo and chemotherapy, 99 percent reported side effects. Checkpoint inhibitors are one of two main types of immunotherapy. 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. He was not involved in the pembrolizumab study.

Keytruda was approved previous year 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. Patients with those mutations (called EGFR and ALK) were not included in this study, and instead were referred to treatment with the drugs that target their mutation.

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Other studies presented at the meeting also highlighted advances in immunotherapy against lung cancer, but were at earlier points in the research and less likely to bring about immediate changes in medical practice.

“For the first time, adding another drug has significantly impacted the long-term outlook for those patients, ” she said.

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 U.S. each year, said Gomez, who was not involved in the new study.

Hellmann's study, called CheckMate 227, found that advanced tumors that contain a lot of genetic mutations - often from smoking - respond particularly well to a combination of two immune therapy drugs, Yervoy and Opdivo, both from Bristol-Myers Squibb.

The other, vehicle T therapy, genetically reprograms a patient's immune T-cells to find and destroy cancer. But many doctors did not adopt it because the trial was small and didnt initially show a survival benefit, Gandhi said. The immunotherapy drugs did not help people with fewer tumor gene flaws.

After a median followup of 10.5 months, those in the immunotherapy group were half as likely to die.

The estimated survival after a year was 69 per cent in those taking the immunotherapy drugs compared to 49 per cent who only had chemotherapy.

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