A new, innovative approach to lung cancer treatment in which immunotherapy is administered prior to surgery is yielding encouraging outcomes in 45% of patients treated in this small, compelling study from researchers on the Stand Up To Cancer-Cancer Research Institute Cancer Immunology Dream Team, according to results presented at the American Association for Cancer Research Annual Meeting 2018, April 16 and simultaneously published online in the New England Journal of Medicine.
"I've been treating lung cancer for 25 years now, and I've never seen such a big paradigm shift as we're seeing with immunotherapy", said Dr. Roy Herbst, chief of Medical Oncology at the Yale Cancer Center.
Companies in recent years have introduced new drugs that harness patients' immune systems to fight tumors, such as Merck's Keytruda and Bristol's Opdivo.
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"What it suggests is that chemotherapy alone is no longer a standard of care", said Dr. Leena Gandhi, a leader of the study and director of the Thoracic Medical Oncology Program at the Perlmutter Cancer Center at New York University Langone Health.
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". If you want to see long-term survival, you've got to give immunotherapy as soon as possible.
Historically, chemotherapy or chemoradiotherapy, is given to lung cancer patients to shrink a large, non-metastasized tumor, and in the past, immunotherapeutic agents have been administered after surgery with limited results. The report shows that 3.8 million people were diagnosed with cancer each year and more than 2.2 million patients died. They remove a cloak that some cancer cells have that hides them from the immune system. The immunotherapy drugs did not help people with fewer tumor gene flaws. Their tumors lacked certain mutations that would have made them eligible for other, "targeted" treatments. In that group, survival without worsening of disease was 43 percent after one year for those on the immunotherapy drugs versus 13 percent of those on chemo.
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How much it ultimately will extend life isn't known - more than half in the Keytruda group are still alive; median survival was just over 11 months for the others.
The results are expected to quickly set a new standard of care for about 70,000 patients each year in the United States whose lung cancer has already spread by the time it's found. The drugs are given through IVs and cost about $12,500 a month.
"It represents a sea change in the way we think about treating lung cancer", she said. "Going forward, it will only get better". The drug alone is already approved to treat patients with high levels of those markers.
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"The data are impressive", Herbst said.