Treatment combo nearly doubles survival time in lung cancer patients, study finds

Combining an immunotherapy drug with chemotherapy nearly doubled the survival time of some lung cancer patients compa...

Posted: Apr 16, 2018 2:00 PM
Updated: Apr 16, 2018 2:00 PM

Combining an immunotherapy drug with chemotherapy nearly doubled the survival time of some lung cancer patients compared to patients treated with chemotherapy alone, new research published Monday in the New England Journal of Medicine showed.

The study results apply only to patients whose lung cancer does not begin in the squamous cells (or surface lung cell layer) and who also lack certain genetic mutations. 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. Worldwide, lung cancer causes 1.69 million deaths annually.

Non-small cell lung cancer is the leading cause of cancer death in the world

Immunotherapy plus chemotherapy nearly doubled survival of patients with advanced disease

"Non-small cell lung cancer is actually the leading cause of cancer death in the world even though it's not the most common cancer," said Dr. Leena Gandhi, lead investigator of the study and director of the thoracic medical oncology program at Perlmutter Cancer Center at NYU Langone Health.

Gandhi explained that the reason non-small cell lung cancer is so deadly is the existing chemotherapy drugs provide only 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.

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

The study, a phase III clinical trial testing treatment effectiveness and side effects, included 616 patients at 118 medical facilities around the globe.

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

Pembrolizumab, sold under the brand name Keytruda, is an FDA-approved drug sold by a subsidiary of Merck & Company, Inc. that sponsored this study.

The combined use of standard chemotherapy with pembrolizumab was "superior in terms of response -- keeping people alive without progression of their cancer -- and improving the overall survival of patients with metastatic lung cancer compared to chemotherapy alone," said Gandhi. "And the differences were not small."

For patients receiving the combined therapy, the chance of death or progression of their cancer was reduced by 48% compared to the patients receiving only chemotherapy. 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%.

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, explained that "about 220,000 patients are diagnosed with lung cancer a year in the US."

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 each year, said Gomez, who was not involved in the new study.

"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 Gomez. Median survival is met when 50% of the patients die.

For non-squamous non-small cell lung cancer patients, median survival with chemotherapy alone is somewhere around 11 or 12 months, he said. Yet, median survival among the study participants who received both immunotherapy and chemo has not yet been reached.

"It's already been 21 months," said 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."

Gomez believes 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."

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 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 get rid of lung cancer for at least some patients."

Mississippi Coronavirus Cases

Data is updated nightly.

Cases: 250869

Reported Deaths: 5481
CountyCasesDeaths
DeSoto17010171
Hinds16091318
Harrison13250193
Rankin10629208
Jackson10216182
Lee8759141
Madison8186161
Jones6222109
Forrest5917118
Lauderdale5808180
Lowndes5309111
Lafayette491192
Lamar480465
Washington4770123
Bolivar3955106
Oktibbeha390380
Panola365076
Pontotoc361152
Monroe3521104
Warren344597
Union341458
Marshall339165
Neshoba3357152
Pearl River323295
Leflore2992105
Lincoln295685
Sunflower280469
Tate269560
Alcorn262653
Itawamba261159
Hancock260458
Pike259977
Scott244745
Prentiss244052
Yazoo242654
Tippah239749
Copiah239149
Simpson233967
Leake229564
Coahoma228554
Grenada217070
Covington210471
Marion208371
Adams203270
Winston199464
Wayne198730
George197938
Attala193158
Newton189142
Chickasaw182944
Tishomingo182159
Holmes168167
Jasper167735
Clay158233
Stone141520
Tallahatchie139234
Clarke137460
Calhoun135121
Smith119423
Yalobusha116134
Walthall111736
Noxubee110222
Greene109129
Montgomery109134
Carroll104121
Lawrence102117
Perry100531
Amite96825
Webster91924
Tunica86021
Claiborne85525
Jefferson Davis84025
Humphreys82624
Benton81023
Kemper76620
Quitman6838
Franklin65815
Choctaw60013
Wilkinson58325
Jefferson53419
Sharkey42417
Issaquena1596
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Alabama Coronavirus Cases

Cases: 420681

Reported Deaths: 6119
CountyCasesDeaths
Jefferson61755921
Mobile30058548
Madison26852186
Tuscaloosa20652266
Montgomery18876305
Shelby18421114
Baldwin16176182
Lee12393101
Morgan12175113
Etowah11687168
Calhoun11078200
Marshall10158107
Houston8556148
Cullman7999105
Limestone796274
Elmore7783101
DeKalb767197
Lauderdale752883
St. Clair7502120
Talladega6145108
Walker5880174
Jackson578841
Colbert529873
Blount529283
Autauga515455
Coffee438156
Dale394381
Franklin365248
Chilton335365
Covington326968
Russell326810
Escambia316142
Dallas302896
Chambers281869
Clarke279633
Tallapoosa2607107
Pike247629
Marion244650
Lawrence242547
Winston225535
Bibb214447
Geneva199535
Marengo197829
Pickens196231
Hale175442
Barbour172336
Butler168458
Fayette167126
Cherokee160030
Henry152721
Monroe145017
Randolph138835
Washington137026
Clay126145
Crenshaw118644
Lamar117519
Cleburne117223
Macon114335
Lowndes109535
Wilcox102621
Bullock98728
Perry96919
Conecuh94220
Sumter88826
Greene75723
Coosa60515
Choctaw51224
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