The addition of atezolizumab to bevacizumab plus chemotherapy extended PFS for patients with non-small cell lung cancer, according to results from the IMpower150 study presented at American Association for Cancer Research Annual Meeting.
Oncologists in the U.S. at Johns Hopkins University and the Memorial Sloan Kettering Cancer Centre administered the immunotherapy drug nivolumab over several weeks to 21 patients with non-small-cell lung cancer prior to surgery.
Patients in the study had an advanced stage of non-squamous non-small-cell lung cancer.
Scientists at Johns Hopkins Bloomberg-Kimmel Institute for Cancer Immunotherapy and Memorial Sloan Kettering Cancer Center found that administering two doses of the anti-PD1 immunotherapy nivolumab for several weeks prior to surgery was not only safe but 45 percent of the patients in the trial responded so well that there was little evidence of the cancer remaining upon follow-up. He said that tumor cells were like bags of hidden proteins that, if exposed, the immune system could use as targets to find and attack cancer. But when given in combination with chemotherapy, the drug is more effective. Patients were not EGFR- or ALK-positive, and had not received systemic therapy for advanced disease.
This Dream Team's approach, created to arrest disease progression within the microenvironment, expands the scope of SU2C's Cancer Interception research portfolio.
The results will likely change the standard treatment for patients with this type of lung cancer, known as metastatic nonsquamous non-small cell lung cancer. The estimated survival after a year was 69 % in those taking the immunotherapy drugs compared to 49 % who only had chemotherapy.
The regimen could demonstrate, "a new standard of care for first-line treatment of this group, irrespective of PD-L1 expression", Gandhi added during the AACR press conference. "A matter of months, not years", she said.
Pembrolizumab, sold under the brand name Keytruda, is an FDA-approved drug sold by a subsidiary of Merck & Company, Inc. that sponsored this study.
Regarding the need for PD-L1 testing and the efficacy across subgroups, Gandhi noted, "I think that for most of us in the field, we would be quite hesitant to give up on PD-L1, or some biomarker to select patients because clearly still not all patients are benefiting".
Historically, chemotherapy or chemoradiotherapy, is given to lung cancer patients to shrink a large, non-metastasized tumor, and in the past, immunotherapeutic agents have been administered after surgery with limited results.
"We don't know how long their survival is going to be and we're excited about that", said Gandhi.
But the median survival among the study participants who received both immunotherapy and chemo has yet to be reached.
For patients with PD-L1-low tumors, defined as those with expression between 1% and 50% (n = 140), median PFS was 9.7 months for those assigned atezolizumab and 6.9 months for those assigned the control regimen (HR = 0.57; 95% CI, 0.38-0.84). The median OS was 19.3 months in the Lynparza arm, compared to 17.1% for chemotherapy.
Dr. Matthew Hellman of Memorial Sloan Kettering Cancer Center in NY, who led the study, and others said it was a validation of the TMB biomarker. These drugs are very, very interesting.
"We have a tool that helps us determine who are the patients that are most likely to benefit from this combination", Hellmann said.