A recent study found pre- and postsurgery immunotherapy could help improve lung cancer survival rates.
- Lung
cancer is a major cause of all cancer-related deaths, with some treatment
options involving surgery to remove cancerous cells from the lungs.
- Researchers
seek the best treatment options to provide the longest postsurgery
survival times.
- A
recent study found that providing immunotherapy pre- and postsurgery helps
improve survival rates compared to only receiving chemotherapy before
surgery.
Lung cancer is the
One of the most common
types of lung cancer is non-small cell carcinoma (NSCLC). A significant
As with other forms of
cancer, lung cancer treatment often involves a
combined approach to help increase the chances of long-term survival.
Immunotherapy is
a common treatment for lung cancer, and scientists are
exploring the best ways to combine it with other therapy approaches. This form
of targeted therapy uses monoclonal
antibodies to help destroy cancer cells and prevent cancer growth.
A recent study published in The New England Journal of Medicineexamined
the perioperative use of the immunotherapy treatment nivolumab among people who had resectable
non-small-cell lung cancer. They compared the use of nivolumab pre and
postsurgery with the use of only chemotherapy before surgery.
Participants who received nivolumab and chemotherapy
before surgery and nivolumab postsurgery were more likely to be cancer-free 18
months later, and more participants in this group experienced a pathological
complete response.
The study points to
nivolumab’s usefulness in improving event-free survival in people with
non-small-cell lung cancer (NSCLC).
Pre- and postsurgical
immunotherapy improves survival rates
This
study was the international CheckMate 77T trial, a phase three, double-blind
study. It included participants with operable non-small-cell lung cancer who
had not received previous systemic anticancer treatment.
Researchers randomized 461
participants to receive either nivolumab or placebo. The intervention group
received nivolumab and chemotherapy before surgery, while the control group
received placebo and chemotherapy every three weeks for four cycles. In total,
229 were in the nivolumab group, and 232 were in the chemotherapy group.
Participants then underwent
surgery within six weeks of this pre-surgical intervention. Within three months
of surgery, the intervention group received nivolumab every four weeks for a
year, while the other group received a placebo.
Researchers looked at
event-free survival as a primary outcome. Secondary outcomes included:
- A complete
lack of viable tumor cells in the primary tumor location and sampled lymph nodes (pathological
complete response) after surgery.
- 10% or less
viable cancer cells in primary tumor location and sampled lymph nodes
(major pathological response) after surgery.
- Overall
safety and survival.
The average follow-up time
with participants was 25.4 months.
Overall, the group that received nivolumab
experienced superior outcomes to the chemotherapy group. Event-free survival at
18 months was 70.2% for the intervention group and 50% for the chemotherapy
group.
“For patients with
resectable stage IIA to IIIB non-small cell lung cancer (NSCLC), neoadjuvant
nivolumab plus chemotherapy followed by surgery and adjuvant nivolumab had a
significantly extended event-free survival compared with neoadjuvant placebo
plus chemotherapy followed by surgery and adjuvant placebo,” non-study author Mahran Shoukier, MD, an oncologist affiliated
with Memorial Hermann, explained to Medical News Today.
Additionally, about a
quarter of the intervention group also experienced a pathological complete
response, while less than 5% of the chemotherapy group did.
About 35% of the
intervention group experienced major pathological responses compared to about
12% of the chemotherapy group.
The groups experienced a
similar number of adverse events, but the number of adverse events that
resulted in treatment discontinuation was higher in the intervention group.
Still, researchers noted that the intervention had no unexpected safety
signals.
“The study showed the importance
of using nivolumab in addition to the chemotherapy in the neoadjuvant regime
for resectable NSCLC (stage IIA to stage IIIB) and then using nivolumab in the
adjuvant setting after surgery. This will extend the event-free survival and
increase the pathological response without unexpected safety signals.”— Mahran
Shoukier, MD, oncologist
More studies on
immunotherapy’s effects on cancer outcomes needed
The
findings offer hope for improving survival rates for this deadly form of
cancer.
“The burden imposed by lung
cancer in the U.S. and the world at large is enormous,” Jack Jacoub, MD, board certified medical
oncologist and medical director of MemorialCare Cancer Institute at Orange
Coast Medical Center in Fountain Valley, CA, told MNT. Jacoub was not involved in the study.
“Just a few years ago, the average survival for
stage III lung cancer — [two-thirds] of the study population — was 1.5 years.
Now, in the era of immunotherapy, this number has been dramatically improved,”
Jacoub noted.
The study reported [that]
70% of patients are now alive and without any evidence of disease at that same
time interval using perioperative therapy and 50% using preoperative therapy
alone, which is tremendous progress. Moreover, the benefit from both approaches
adds very little to the side effects already known with chemotherapy alone,” he
continued.
Despite the promising
implications, the study does have certain limitations.
First, it focused on a
specific cancer type, meaning the results cannot necessarily be generalized to
other cancer types. Less than 40% of participants completed one full year of
nivolumab treatment post-surgery, which could have also impacted the results.
Researchers also
acknowledge that Black participants were underrepresented, which suggests the
need for more diverse follow-up. About 70% of the participants were male, so
future research could include more female participants.
“Although we do not know
overall survival — follow-up beyond the 2 years reported — it obviously will
blow away the recent historical numbers with chemotherapy alone. Hence, this is
a very significant trial and will likely change practice. This treatment will
likely be available for stage II and III resectable lung cancer patients very
soon in the U.S., and uptake by cancer treatment providers will likely be rapid
thereafter.”— Jack Jacoub, MD, board certified medical oncologist.
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