New research published recently in the New England Journal of Medicine, compared patients treated with chemotherapy alone, and lung cancer patients who combine immunotherapy with chemotherapy as a treatment. The latter has double the chance of survival in this study.
Patients whose lung cancer does not begin in the squamous cells (or surface cell layer of the lungs) and also lack specific genetic mutations are the ones that the study results apply to. Non-small Small cell lung cancer is more common than small cell lung cancer and accounts for about 85% of lung cancers. Worldwide, lung cancer causes 1.69 million deaths annually.
Dr. Leena Gandhi, lead investigator of the study and director of the thoracic medical oncology program at Perlmutter Cancer Center at NYU Langone Health said, “even though Non-small cell lung cancer is not a most common cancer, it is, actually, the leading cause of cancer death in the world.” According to Dr. Gandhi, the reason behind the extreme fatality of non-small cell lung cancer is the existing chemotherapy drugs. They only provide limited survival benefits for patients. “A matter of months, not years,” she said.
Immunotherapy, which harnesses the body’s immune system to attack tumors, is known to improve survival in patients who have already been treated with chemo. Dr. Ganghi wondered, If using immunotherapy earlier in treatment, together with chemotherapy, would have any benefit for the patients?
Compared to the patients receiving only chemotherapy, the chance of death or progression of lung cancer for patients receiving the combined is therapy reduced by 48%
Out of 616 patients at 118 medical facilities around the globe, a smaller group of patients received chemotherapy alone, while a group of 400 patients received standard chemotherapy in addition to the immunotherapy drug, pembrolizumab (in the study, a phase III clinical trial testing). Pembrolizumab, sold under the brand name Keytruda, is an FDA-approved drug sold by a subsidiary of Merck & Company, Inc. that sponsored this study.
According to Dr. Gandhi, the combination of standard chemotherapy along with pembrolizumab was “superior in terms of response -keeping people alive without progression of their cancer – and improved the overall survival of patients with metastatic lung cancer compared to chemotherapy alone” “And the differences were not small.”
Compared to the patients receiving only chemotherapy, the chance of death or progression of their cancer for patients receiving the combined therapy reduced by 48%. The most common side effects were nausea, anemia, and fatigue and in both groups, about 65% of
patients experienced severe side effects. However, the risk of one side effect, acute kidney injury, was higher for combination treated patients: 5.2% vs. 0.5%.
According to 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 New York, “about 220,000 patients are diagnosed with lung cancer, a year in the US.” Dr. Gomez, who was not involved in the new study said each year, 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 US.
“What we look at in these trials is overall survival -how long patients live- and we look at a number called the median survival -how long 50% of patients live,” said Dr. Gomez. Median survival is met when 50% of the patients die. Median survival with chemotherapy alone is somewhere around 11 or 12 months, For non-squamous non-small cell lung cancer patients, he said. However, median survival among the study participants who received both immunotherapy and chemo has not yet been reached.
“It’s already been 21 months,” remarked Dr. Gomez. “The differences are big enough now that you know it’s going to be a very big number and it’s important to get this information to people so they can start using this regimen.” Dr. Gomez has confidence that it could be as high as double chemotherapy alone, “which would be very impressive,” he said. “I only treat lung cancer and I’ve been doing that for about 20 years. These drugs are very, very interesting. Now, not everybody benefits, unfortunately, but some of the people
who benefit seem to benefit in a way we’ve never seen.”
24 months ago, it was recalled that a patient with advanced lung cancer whose tumor disappeared and has not grown back after finishing treatment, Dr. Gomez observed, “I’m now becoming much more optimistic that if we can really find a way to perfect 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 getting rid of lung cancer for at least some patients.”
Such a research as this must be commended because of its outstanding effort to ensure the survival of lung cancer patients. However, much more efforts need to be made so as to ensure the widespread of this life-saving treatment to a large number of people to save more lives.