Survival Significantly Improved With Frontline Pembrolizumab Combination in NSCLC

Merck Expands Lead Over Bristol Meyers in Lung Cancer Drugs

A study on lung cancer patients found that activating the immune system can prompt tumours into spreading friendly T-cells around the body, significantly reducing the chance of cancer returning after surgery.

Two promising new studies suggest that combining immune therapy drugs with chemotherapy may improve survival.

Keytruda was approved past year as an initial treatment with chemo for the most common form of advanced lung cancer, but doctors have been leery to use it because that was based on a small study that did not show whether it prolongs life.

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. They remove a cloak that some cancer cells have that hides them from the immune system.

Researchers say a drug called Keytruda, when combined with standard chemo, cut the risk of dying in half, compared to just chemo treatment alone.

"The remarkable results of the team led by Drew Pardoll reflects both the power of collaboration between Stand Up To Cancer, the Cancer Research Institute, and the institutions and researchers participating in this Dream Team, as well as Stand Up's funding model which integrates semi-annual, rigorous, in-person reviews, enabling teams to pivot to where the science leads, and to allocate Team resources to trials which are most likely to benefit patients", said Nobel Laureate and Chairperson of the SU2C Scientific Advisory Committee (SAC) Phillip A. Sharp, PhD, Institute professor at the MIT Koch Institute for Integrative Cancer Research.

About 80 percent of lung cancer cases are attributed to smoking. SU2C is now funding four Cancer Interception teams focusing on lung and pancreatic cancer. It's the biggest win so far for immunotherapy, which has had much of its success until now in less common cancers.

The results supported the hypothesis that chemotherapy has immunogenic properties that might augment the activity of immunotherapeutic agents and extend the benefits of an agent like pembrolizumab to patients who have tumors that do not express PD-L1, she added. "Pembrolizumab plus pemetrexed (Alimta) and platinum may be a new standard of care for first-line treatment of metastatic nonsquamous NSCLC, irrespective of PD-L1 expression". "We are going to have major increases in survival in the next 20 years, which would have been hard to say ten or 15 years ago".

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

Still, the drug has side effects - notably, about 5 percent of patients in the immunotherapy group experienced acute kidney problems, compared with 0.5 percent of patients in the control group.

"We were all waiting to see a definitive Phase III study that showed very clear cut results", said Dr. Leena Gandhi, the study's primary investigator and director of thoracic medical oncology at NYU Langone in NY.

"We know that chemotherapy is not what people want", Kmiec said. Median survival is met when 50% of the patients die.

Several other questions remain, including whether patients with high levels of PD-L1 expression on their tumor cells who have already been found to benefit from this type of immunotherapy reap any extra benefits from chemotherapy, Yau said.

Dr. Gomez thinks the survival rate could be as high as double chemotherapy alone, "which would be very impressive", he said. We do need to focus more on how to differentiate the patients who will get the most benefit.


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