Published: Tue, April 17, 2018
Medical | By Johnnie Horton

Immune therapy key to extending lung cancer patients' lives

Immune therapy key to extending lung cancer patients' lives

Keytruda - developed by pharmaceutical giant Merck, which also funded the study - turns off cancer cell's protective functions, letting the immune system recognize and attack the cells.

The new study, led by Dr. Leena Gandhi of NYU's Perlmutter Cancer Center, gives that proof. A widely used immunotherapy drug appears to be useful in a greater number of patients with lung cancer. In it, 616 patients were given chemo and some also received Keytruda.

Side effects were nearly universal - 99.8 percent of patients who received Keytruda and chemotherapy experienced them.

Rates of serious side effects were similar, but twice as many in the Keytruda group dropped out because of them.

The first study found that when the immunotherapy drug Keytruda (pembrolizumab) was combined with standard chemotherapy, the chance that a patient would die within the next 11 months plummeted by more than 50 percent, compared with being treated with chemo alone. While that's a notable difference, the drug did not stop cancer entirely in most patients.

The therapy turned out to be not only safe but 45 percent of the patients in the initial trial responded so well that there was little evidence of the cancer remaining upon follow-up.

Gandhi wondered, Would using immunotherapy earlier in treatment, alongside chemotherapy, do more for patients?

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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 United States each year, said Gomez, who was not involved in the new study. "It's not a home run yet but it's a pretty good double".

In a study published on Monday in the New England Journal of Medicine, Scientists at Johns Hopkins Bloomberg-Kimmel Institute for Cancer Immunotherapy and Memorial Sloan Kettering Cancer Center administered two doses of the anti-PD1 immunotherapy nivolumab for several weeks prior to surgery. They remove a cloak that some cancer cells have that hides them from the immune system. Of the two types of lung cancer, small cell lung cancer is less common than non-small cell lung cancer, which affects up to 85% of all lung cancer patients.

A course of treatment with Keytruda can cost $150,000, so an expanded market could mean billions of dollars in additional revenue. Those not given Keytruda were allowed to switch to it if their cancer worsened.

Notably, the incidence rate of lung cancer among non-smoking Chinese females is rising comparatively faster compared with those in western countries.

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". However, as in the latest study, the effects frequently don't persist for most patients.

One group of 400 patients received standard chemotherapy and the immunotherapy drug pembrolizumab, while a smaller group of patients received chemotherapy. 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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