According to the results of a recent clinical trial, less may be more in the treatment of metastatic or recurrent non-small cell lung cancer (NSCLC).
Dr. David Carbone, a professor of medicine and director of the James Thoracic Center at The Ohio State University Wexner Medical Center, stated, “The results show that we may not need four cycles of chemotherapy with immunotherapy to have good efficacy.”
Dr. Carbone’s study evaluated two cycles of chemotherapy combined with the immunotherapies Opdivo and Yervoy compared to the standard four cycles.
Data from the research, known as CheckMate-9LA, established that treatment with Opdivo and Yervoy plus two cycles of chemotherapy reduced the risk of death among patients by 31% compared with the chemotherapy-only regimen.
The results further indicated that patients assigned to the Opdivo- Yervoy regimen had a median survival rate of 14.1 months versus the 10.7 months in the group given four cycles of chemotherapy alone. Carbone and colleagues noted that the longer the follow-up, the more the combination therapy seemed to improve survival rates.
The results from this study led the Food and Drug Administration to approve the combination regimen early in 2021 for the treatment of these patients.
There are other benefits besides the improvement in survival rate. The combination treatment also gives patients a less toxic treatment option.
Estimates from the CDC pinpoint that approximately 650,000 patients with cancer in the United States receive chemotherapy. Chemotherapy drugs are used to kill fast-growing cancer cells, but they are not without side effects. Many of those side effects are prolonged, debilitating, and toxic, like fatigue, hair loss, nausea, and anemia.
“It is not a chemo-free regimen, but it is only two cycles of chemo instead of four,” Carbone said regarding the Opdivo-Yervoy regimen. “People do not like chemotherapy, and as someone who has had chemotherapy, I know what that is like.”
Dr. Carvone noted that the combination also helps patients with squamous cell cancers avoid two cycles of full-dose paclitaxel, which can be toxic. Non-squamous cell cancers are treated with the chemotherapy drug pemetrexed, as well as the immunotherapy Keytruda. During this regimen, pemetrexed is given every three weeks for two years, with steroids at every cycle. “With the standard chemotherapy-plus-Keytruda regimen, you have maintenance chemotherapy that goes on for two years, and that confers a chronic toxicity from the chemotherapy,” Carbone explained. “The (Opdivo-Yervoy regimen) eliminates all of these chemotherapy doses except for two and all of the two years of steroid doses, which might help the durability of response.”
“I think patients should be aware that it is an available and reasonable option,” Carbone concluded, adding that there is potential to use this concept in cancer settings other than NSCLC, though that has not been investigated. “It is a great time in lung cancer, but there is still a long way to go, that is for sure.”