Immunotherapy Improves long-term survival in Lung Cancer

When compared to single-agent chemotherapy, a global study led by UCL and UCLH found that the cancer immunotherapy atezolizumab significantly improved the overall survival of advanced stage non-small cell lung cancer patients who were unable to be treated with platinum-containing chemotherapy.

The trial findings, reported today in The Lancet, are encouraging for patients with non-small cell lung cancer who are not candidates for standard-of-care platinum-based chemotherapy due to concerns about their capacity to tolerate the treatment.

With around 2.2 million new cases and 1.8 million deaths each year, lung cancer is the leading cause of cancer death globally. The vast majority of patients have advanced non-small cell lung cancer (NSCLC).

First-line immunotherapy with or without platinum-based doublet chemotherapy (PDC) is now the standard of care treatment for the fittest individuals with advanced stage NSCLC. This comes after a series of randomized trials that were limited to ‘fit’ subjects with a median age of 65 or younger who could tolerate PDC.

However, more than 40% of patients with advanced stage NSCLC are in poor condition and are frequently older with major medical co-morbidities. Because of low tolerance or toxicity concerns, traditional PDC treatment is ineffective for many of these patients, leaving them with few therapeutic options. They are frequently given less effective single-agent chemotherapy or the greatest supportive care available.
Most treatment guidelines do not currently advocate immunotherapy treatment due to a lack of randomized outcomes indicating that it is safe, well tolerated, and improves overall survival in this high-risk population.

This is the first randomized phase III trial of atezolizumab (Tecentriq) as first-line immunotherapy in an advanced NSCLC population deemed unsuitable for traditional platinum-chemotherapy. The trial aimed to compare the effectiveness, safety, and overall survival rate of first-line immunotherapy with atezolizumab to single-agent chemotherapy in patients with advanced stage NSCLC. The patients were divided into two groups, with 302 receiving atezolizumab and 151 receiving single-agent chemotherapy.

The study found that atezolizumab significantly improved overall survival and resulted in a clinically meaningful long-term survival benefit, with twice as many patients (24%) remaining alive at two years compared to those treated with chemotherapy (12%), despite the fact that over 50% of chemotherapy patients who were still alive at two years receiving subsequent immunotherapy.

Professor Siow Ming Lee (UCL Cancer Institute and UCL Hospitals), who chaired the study Steering Committee and conceptualized the study design, said, “For over two decades, clinical trials have failed to provide significant therapeutic benefits to older NSCLC patients with poor health who are unfit for standard platinum doublet chemotherapy.”

“IPSOS is the first randomized trial to show that immunotherapy treatment with first-line atezolizumab treatment significantly improves overall survival compared to single-agent chemotherapy for these poor prognosis patients, with twice as many remaining alive at two years. The treatment also resulted in stabilized or improved health-related quality of life measures, and no new safety concerns were identified.”

Source Link