The idea of turning the immune system against cancer got a big boost over the last few days, with a trio of studies showing the approach’s effectiveness against lung cancer.
Lung cancer is the leading cause of cancer death in the United States, killing more than 150,000 people a year. For cancer that has spread beyond the lungs, the five-year survival rate is historically just 1%.
But trials over the last five years have repeatedly shown more uses for immune therapy in lung cancer, and the new research confirms that nearly all lung cancer patients will now receive immune therapy, said Patrick Forde, the first author on one of the studies and a lung cancer specialist at Johns Hopkins Medical.
“Today is a big day in lung cancer,” Forde said. The three studies were all presented at the annual conference of the American Association for Cancer Research, now ongoing in Chicago.
"It’s pretty amazing times to have so many positive studies at once,” added Matthew Hellmann, a lung cancer specialist at Memorial Sloan Kettering Cancer Center, who led one of the studies. “This is a huge step forward for patients with lung cancer to have so many new options.”
Hellmann’s study, called CheckMate 227, found that advanced tumors that contain a lot of genetic mutations - often from smoking – respond particularly well to a combination of two immune therapy drugs, Yervoy and Opdivo, both from Bristol-Myers Squibb.
Another study found that patients with advanced cancer fared better if they received Keytruda, an immune therapy from Merck, along with chemotherapy. More than 69% of the combination group were alive at a year, compared to 49% of those who used chemotherapy alone.
In Forde’s small study of patients with early-stage disease, patients who received Opdivo around the time of surgery fared much better than those who received chemotherapy alone. Roughly 20% of patients see their tumors respond when they get chemotherapy before surgery; in this study, among patients who received Opdivo instead, 45% of tumors had regressed and in three patients there was no remaining tumor at all, Forde said.
The hope is that such early treatment, when the patient is still quite healthy, will train their immune system to keep fighting off the cancer long-term, Forde said.
The new studies suggest that different types of tumors should receive different treatment regimens, all including immune therapy, Hellmann said.
In his own research, Hellmann said, his team finessed the dosing of the two drugs to minimize side effects, and found that the combination therapy was significantly better than chemotherapy alone against tumors with a lot of mutations. At one year, 43% percent of patients on the combination therapy had not seen any progression of their cancer, compared to 13% of those with chemotherapy.
So-called tumor mutational burden can be measured with tests that are already routinely done in many cancer centers, Hellmann said, so they should be readily accessible.
For advanced patients without a lot of mutations but who have lots of immune cells in their tumor, Keytruda alone looks like a good option, he said.
And for those with neither a lot of mutations nor a lot of immune cells, chemotherapy plus Keytruda seems to be the best choice, he said.
The new research, Hellmann said, offers “a good argument for any of those.”