New Wins in Combination Therapy for Lung Cancer
Cancer Lung Cancer Checkpoint Inhibitor

New Wins in Combination Therapy for Lung Cancer

Dr. Talia Henkle
Dr. Talia Henkle

In 10 seconds? Early-stage lung cancer patients who received both chemotherapy and checkpoint blockade inhibitor therapy before undergoing cancer removal surgery had better survival outcomes than those who received chemotherapy alone.

What’s the story? It seems that every single-agent cancer treatment trial recommends that combination therapy approaches (AKA combining multiple treatments) be tried next to improve treatment outcomes. But like everything in cancer, it’s not that simple. What agents should be combined and how? Finally, we’re starting to answer those questions for the cancer that kills the most people worldwide.

What cancer is that? Lung cancer. Even among early-stage lung cancer patients who can undergo surgery to remove their tumors, 30-55% of those patients’ tumors will come back–frequently with mortal consequences. To prevent this, researchers have designed experiments to test whether offering supplemental cancer treatments, either pre- or post-surgery, will improve outcomes for lung cancer patients.

Any progress? Yes! Interestingly, pre-operative combination treatment of a checkpoint inhibitor (anti-PD1) and chemotherapy led to a significantly higher progression-free survival rate (AKA the percent of patients whose cancer didn’t come back or didn’t get worse) than those who received chemotherapy alone (76.1 vs 63.4% at 1 year). And importantly, the patients in the combination treatment group didn’t experience any more serious side effects than those who were treated with chemotherapy alone.

That’s great! Do they know why it worked so well? They have some ideas! Pre-operative cancer treatment has multiple advantages. For one, it can reduce the size of the tumor to make surgery easier or even unnecessary. Second, checkpoint inhibitors activate cancer killing T cells, which boosts T cells’ ability to hunt down and kill any tumor cells that may have been missed by the surgery before they can cause major problems. This may be why those who received the combination treatment made out better than those who received chemotherapy alone.

Lung cancer patients who received checkpoint inhibitor treatment (nivolumab) and chemotherapy had a higher event-free survival rate than those who only received chemotherapy. Source: Forde PM, et al. N Engl J Med. 2022 May 26;386(21):1973-1985.

That great! Right? But experts note that a few things need to be done before this three-pronged treatment strategy (chemotherapy, checkpoint blockade and surgery) is recommended. First, since this study only followed up with patients for about 2 years, they need to ensure that the survival benefits are indeed durable and long-lasting. Second, about 20% of the patients also received chemotherapy after surgery. More research needs to be done to explore whether post-operative treatment is necessary, and if so, how patients should be selected to receive it.

Anything else? Finally, this approach requires collaboration between multiple medical specialties (surgery, pathology, and oncology), which is logistically challenging for many cancer care centers to accommodate. Still, this study is exciting as it shows promise for a brighter future for those with early-stage lung cancer.

Getting technical

Scientists and doctors love to give technical terms to everything.

In cancer treatment, ‘adjuvant therapy’ refers to treatments that are administered after cancer removal surgery.

‘Neoadjuvant therapy’ refers to cancer treatments that are administered prior to cancer removal, which is the treatment strategy discussed in today’s digest!

Dr. Talia Henkle has distilled 2 research papers, saving your 7 hours of reading time

The Science Integrity Check of this 3-min Science Digest was performed by Dr. Jacquelyn Bedsaul

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