Researchers Report Advances in Lung Cancer Immunotherapy

three researchers working in their lab

Scientists presenting at the American Association for Cancer Research Annual Meeting in Chicago have found new and promising ways to use immunotherapy to treat people with some types of non-small cell lung cancer (NSCLC). Results from these 3 studies were also published April 16 in the New England Journal of Medicine.

Keytruda plus chemo shows survival benefit in advanced disease

An international group of researchers found that giving advanced NSCLC patients Keytruda (pembrolizumab) along with chemotherapy as initial treatment helped them live longer than just chemo alone.

Keytruda is a type of immunotherapy drug called a checkpoint inhibitor. It blocks a protein called PD-1, which is found on the surface of some cancer cells and helps them avoid being found and destroyed by the body’s immune system. Anti-PD-1 drugs can help the immune system recognize the cancer cells and attack them.

A randomized trial of 616 people with metastatic non-squamous NSCLC was designed to measure overall survival (how long someone lives after starting treatment) and progression-free survival (how long someone has cancer without it getting worse). Of those in the study who received chemotherapy and Keytruda combined, 69% had an overall survival of at least 1 year compared with 49% of those who received chemotherapy and a placebo. Progression-free survival was 8.8 months for the Keytruda group compared with 4.9 months for the placebo group.

Immunotherapy shows promise for NSCLC with high tumor mutational burden

Another group of researchers from cancer centers around the world found that combining the immune checkpoint inhibitors Opdivo (nivolumab) and Yervoy (ipilimumab) as a first treatment improved progression-free survival in people with advanced NSCLC and a high tumor mutational burden.

Cancer patients are said to have a high tumor mutational burden if they have a large number of gene mutations in their tumor cells. In this study, researchers considered participants to have a high tumor mutational burden if they had at least 10 mutations per megabase. A megabase is part of a DNA strand.

Tumor mutational burden may be a way to predict which people will respond to treatment with immunotherapy drugs, such as Opdivo and Yervoy. These drugs work by blocking different proteins on cancer cells that help them avoid the immune system. Blocking these proteins helps the immune system find and kill the cancer cells.

In the trial, 299 people with advanced NSCLC and a high tumor mutational burden who had not been previously treated received either Opdivo and Yervoy, or they received chemotherapy. After 1 year, 42.6% of those who received Opdivo and Yervoy saw no worsening of their cancer (progression-free survival) compared with 13.2% who received chemotherapy. Researchers plan to continue to follow the participants so that they can calculate whether the drugs helped them live longer (overall survival).

Immunotherapy before surgery shows benefit in small study

A group of US researchers conducted a small study that found that giving immunotherapy before surgery could often kill off most of the cancer cells in people with resectable (removable) NSCLC. This treatment differs from the current standard treatment, in which chemotherapy is often given to shrink a tumor before surgery.

In the study, 20 people with early stage NSCLC received Opdivo (nivolumab) about a month before having their tumors surgically removed. At the time of surgery, at least 90% of the tumor cells were no longer alive in 9 participants (45%). After an average follow-up period of 1 year, 80% of patients were alive and their cancer had not come back.

This small, early-phase trial was designed to find out if the treatment was safe. It showed that giving Opdivo before surgery was associated with few side effects and did not delay surgery in any of the patients. Because the outcomes were so positive, more studies will likely be conducted to test this type of treatment in more people.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Pembrolizumab plus Chemotherapy in Metastatic Non–Small-Cell Lung Cancer. Published April 16, 2018 in the New England Journal of Medicine. First author Leena Gandhi, MD, PhD. NYU Perlmutter Cancer Center, New York.

Nivolumab plus Ipilimumab in Lung Cancer with a High Tumor Mutational Burden. Published April 16, 2018 in the New England Journal of Medicine. First author Matthew D. Hellmann, MD. Memorial Sloan Kettering Cancer Center Hospital, New York.

Neoadjuvant PD-1 Blockade in Resectable Lung Cancer. Published April 16, 2018 in the New England Journal of Medicine. First author Patrick M. Forde, MB, BCh. Johns Hopkins University School of Medicine, Baltimore.


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