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New Studies Show Immune Treatments Could Be Key in the Fight Against Lung Cancer

From TIME - April 16, 2018

Researchers report some of the most encouraging results yet for treating lung cancer with the latest immune-based treatments, most of which have been approved to treat other types of tumors.

In three papers presented at the American Association for Cancer Research annual meeting, and published simultaneously in the New England Journal of Medicine, lung cancer experts found innovative ways to weaken lung tumors to improve peoples chances of surviving the disease.

There is definitely a high unmet need, says Patrick Forde, assistant professor of oncology and associate member of the Bloomberg-Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, of the lack of effective treatments for lung cancer. Currently more than half of people who are treated even at early stages of the disease can expect the cancer to return, and chemotherapy typically leads to only a 5% improvement in peoples chances of living five yearsbut an up to 70% chance of being exposed to serious toxicities.

The studies involve a group of immune-based cancer drugs called checkpoint inhibitors, which are designed to rip away the molecular cloak behind which cancer cells hide from the immune system. The medications target a protein called PD-1, its related PD-L1, or CTLA-4, which protect the bodys cells from being killed by immune cells; because tumors are normal cells growing out of control, they take advantage of this molecular security blanket to avoid getting detected by immune cells. A series of checkpoint inhibitor drugs, first approved in 2011 initially for treating melanoma, expose the tumor cells to the immune system. Based on their success in treating skin cancers, scientists are now studying this group of drugs in a number of other cancers, including tumors in the lung.

In one study, called CheckMate-227, researchers tested whether a combination of two of these checkpoint inhibitor drugs could keep tumors from growing better than the standard treatment of chemotherapy in people with advanced non small cell lung cancer (NSCLC). Nearly 300 people were randomly assigned to receive either the combination of the immune-based drugs or the traditional chemotherapy treatment. After nearly a year, the lung cancer in people taking the immunotherapy was 42% less likely to have progressed than among people getting chemotherapy.

Whats more, say the studys authors, doctors may also figure out which people are most likely to respond to the two-drug combination of nivolumab (Opdivo) and ipilimumab (Yervoy) and which are not. In the study, he and his colleagues found that people whose tumors had more mutations enjoyed the longest time period during which their cancers did not progress.

Currently, lung cancer treatments rely heavily on chemotherapy, but doctors are shifting toward a more customized and precise way of treating each persons disease in order to improve their chances of survival. For example, newer targeted therapy drugs home in on specific genetic mutations that are responsible for driving a persons cancer. Doctors can also determine if a persons lung cancer is genetically vulnerable to the checkpoint inhibitor drugs tested in the current study. Putting together everything that doctors currently know about lung tumors, more than half of people with lung cancer can avoid chemotherapy and get more precision-based treatments, says Dr. Matthew Hellmann of the Memorial Sloan Kettering Cancer Center (MSKCC), lead author of the study. In addition, a year after treatment, three times more people on immunotherapy were doing well compared to those who just got chemotherapy.

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