Lung cancer survival improves with immunotherapy, according to studies

Frederick Owens
April 18, 2018

Merck & Co's immunotherapy Keytruda plus chemotherapy significantly improved overall survival in newly-diagnosed patients with advanced non-small cell lung cancer in a closely-watched study, cementing its lead position over Bristol-Myers Squibb Co and others in the most lucrative oncology market. Twice as many patients were alive without disease progression when they received pembrolizumab in addition to chemotherapy. The results were also published yesterday in the New England Journal of Medicine.

In the IMpower 150 study, Socinski and colleagues assessed the addition of atezolizumab in the first-line setting for 692 patients with nonsquamous NSCLC. The estimated survival after a year was 69 % in those taking the immunotherapy drugs compared to 49 % who only had chemotherapy.

Press briefing moderator Alice Shaw, MD, of Massachusetts General Hospital Cancer Center in Boston, said results did establish a new standard of care for untreated, advanced nonsquamous NSCLC.

Findings showed the Keytruda-pemetrexed-platinum chemotherapy combination significantly improved overall survival, reducing the risk of death by half compared with chemotherapy alone.

Lung cancer is the leading cause of cancer deaths in DE and nationwide, which is why doctors at Christiana Care Health System are working towards new approaches to catch it in early stages and improve treatments.

"I never would have thought that chemotherapy combinations would be where we are going with immunotherapy, and I resisted for a long time because my feeling was that immunotherapy could be used without chemotherapy", Herbst told MedPage Today. It seems that the more creative use of these miraculous drugs can help fight off lung cancer too.

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Yau noted, however, that pembrolizumab by itself works only in a minority of patients. Patients whose tumors had sensitizing EGFR mutations or ALK alterations were excluded. On average, patients who received the combination therapy lived twice as long as patients who were not treated with it.

For patients with PD-L1-low tumors, defined as those with expression between 1% and 50% (n = 140), median PFS was 9.7 months for those assigned atezolizumab and 6.9 months for those assigned the control regimen (HR = 0.57; 95% CI, 0.38-0.84). Serious side effects were a little more common in the chemo group. The median OS was 19.3 months in the Lynparza arm, compared to 17.1% for chemotherapy. One other died of lung cancer, while another died due to an unrelated head injury.

The ORR per blinded, independent central radiologic review in the pembrolizumab arm versus the chemotherapy alone arm was 47.6% (95% CI, 42.6-52.5) and 18.9% (95% CI, 13.8-25.0) (P .001), while there was a disease control rate of 84.6% versus 70.4%, and the median duration of response was 11.2 months versus 7.8 months in the pembrolizumab versus control arms, respectively. PFS favored pembrolizumab across PD-L1 expression status and achieved statistical significance for patients with tumors that had intermediate or high PD-L1 expression.

The overall response rate - those with significant tumor shrinkage - was 45 percent for the immunotherapies versus 27 percent for chemotherapy.

The total incidence of adverse events, grade 3-5 events, and fatal adverse events was similar in the two groups.

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