A New Option for Some People With Lung Cancer: How This Immunotherapy/Chemotherapy Combo Can Increase Treatment Success

Adding nivolumab (Opdivo) to chemotherapy prior to surgery increased the pathological complete response rate (PCR) to 24%, compared with 2.2% with chemotherapy alone. PCR means that samples gathered from the lung and lymph nodes during surgery and reviewed by a pathologist show no remaining cancer cells.  In addition, combining nivolumab with chemo did not increase overall toxicity of the treatment or cause delays to surgery.

Dr. Patrick Forde, associate professor at Sidney Kimmel Comprehensive Cancer Center and Bloomberg~Kimmel Institute for Cancer Immunotherapy at Johns Hopkins University, explained that the standard treatment for resectable lung cancer is surgery to remove the tumor. “Despite this, many patients experience recurrence of their lung cancer and when this happens, it is usually incurable,” he said, noting that chemotherapy alone given before or after surgery improves patient survival by only 5% at five years.

Related: An In-Depth Overview of Lung Cancer

"For the first time in a phase III trial, we see the potential for an anti-PD-1 immunotherapy to improve outcomes in earlier-stage NSCLC. We are highly encouraged by the marked improvement in pCR, the overall good tolerability, and the absence of impact on surgery feasibility when nivolumab is added to neoadjuvant chemotherapy," Dr. Forde said. "Data accumulated to date from several retrospective studies show a clear trend that patients who achieve a pCR with neoadjuvant chemotherapy live longer than those who do not."

Overall, lung cancer is the second most common form of cancer in the United States. It's also the most deadly. NSCLC makes up about 85 percent of all lung cancer cases. The American Cancer Society estimates that there will be about 235,760 new cases of lung cancer in 2021 and about 131,880 deaths.

Related: More Treatment Options for Patients with NSCLC Help Turn Patients Into Survivors

The trial involved adults with stage 1b-3a resectable NSCLC with no known gene alterations.  179 patients received nivolumab plus platinum-doublet chemotherapy and 179 patients received chemotherapy alone.

The improvement in PCR with nivolumab plus chemo was consistent across all subgroups, including disease stage, NSCLC subtype, PD-L1 status, tumor mutational burden status and for both men and women.

It’s possible that this trial will open the door for other immunotherapy/chemotherapy combos to be considered.  “Watch this space,” Dr. Charles Swanton, professor of cancer medicine at The Francis Crick Institute at University College London Hospitals said. “We are awaiting results of further studies.”

About Non-Small Cell Lung Cancer

Non-small cell lung cancer has three subtypes:

• Adenocarcinoma is the most common type. It grows in cells that secrete mucus. Found on the outside of lungs, it's more likely to be found before it spreads.
• Squamous cell carcinoma starts in the flat cells that line the airways.
• Large cell carcinoma can start anywhere, and grows and spreads faster than the other types.

While small-cell lung cancer is closely linked to smoking, anyone can get non-small cell lung cancer. About one in five men and half of the women who get it are non-smokers.

Contributing: Sonya Collins

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