Metastatic Lung Cancer: Immunotherapy Gives Hope

Metastatic Lung Cancer: Immunotherapy Gives Hope Posted By:
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In 2005, the 5-year survival rate for patients with stage IV or metastatic non-small-cell lung cancer (NSCLC)—the most common type of lung cancer—was a mere 2%. In 2019, that number has risen to 5%, likely due to the development of immunotherapy drugs to treat NSCLC. However, a 3% increase in the 5-year survival is modest at best.

I cannot completely discount targeted therapies in lung cancer. Certain molecular targets in NSCLC have been identified in the past 15 years, and the use of targeted agents to treat these types of NSCLC has certainly improved outcomes. However, the large majority of patients with NSCLC do not have a molecular abnormality to target.

Immunotherapy drugs are monoclonal antibodies designed to inhibit the "turning off" by the cancer's cells to T-cells in the immune system. Specifically, they can disrupt pathways that the cancer uses to evade the immune system, thus leaving the tumor vulnerable to the activated T-cell killer mechanisms.

In a stunning update at the American Society of Clinical Oncology conference in early June 2019, the original Keynote 001 trial, which studied use of the PD-1 inhibitor pembrolizumab for NSCLC, released its 5-year overall survival data. This phase 1 study was conducted between 2012 and 2014, then went on to further phases of study. Patients with NSCLC who received pembrolizumab had a 23.2% chance of being alive at 5 years from diagnosis. If the patient exhibited a PD-L1 tumor proportion score of greater than 50%, that 5-year survival rate rose to 29%. This is obviously a huge improvement to the 2% to 5% 5-year survival rates in lung cancer over the past 14 years.

Patients diagnosed with metastatic NSCLC are generally living with a death sentence. As oncology providers we historically have discouraged discussion of 5-year survivals with patients due to the highly unlikely chances they had of surviving that long. But now, in the era of immunotherapy, this will change the conversation we have with patients. While it is still less likely to live 5 years with this disease, it is no longer considered rare. With metastatic lung cancer patients able to survive for years, we may see an uprising in patient advocacy for this group who have, for so long, been in the vast minority of cancer survivors.

References
  • American Cancer Society. Cancer Facts & Figures. 2005. www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2005/cancer-facts-and-figures-2005.pdf. Accessed June 26, 2019.
  • Garon EB, Hellmann MD, Rizvi NA, et al. Five-year overall survival for patients with advanced non-small-cell lung cancer treated with pembrolizumab: results from the phase 1 KEYNOTE-001 study. J Clin Oncol. 2019:37. Epub ahead of print.

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Filed under: Oncology/Hematology

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