Patients with resectable lung cancer have long faced bleak prospects. Standard treatment has been to remove the tumor, yet most patients experience a lung cancer recurrence after surgery, and when this happens it usually is incurable. Chemotherapy, using the drugs cisplatin or carboplatin, known as platinum-based chemotherapy, given either before or after surgery, improves patient survival by only 5% at five years.
Now there’s a promising development from researchers at Johns Hopkins Kimmel Cancer Center and the Bloomberg~Kimmel Institute for Cancer Immunotherapy.
The Johns Hopkins team found that adding the immunotherapy drug nivolumab to chemotherapy before surgery for patients with operable non-small cell lung cancer (NSCLC) — the leading cause of cancer deaths worldwide — reduced the risk of recurrence of the cancer or death by more than one-third, according to results from the phase III CheckMate-816 trial. This strategy also achieved a nearly 12-fold increase in pathological complete response — meaning no active cancer remaining when the tumor was removed — over patients who received chemotherapy alone.
The study resulted in Federal Drug Administration approval of the first immunotherapy/chemotherapy combination treatment for patients with operable non-small cell lung cancer — the first FDA approval of a neoadjuvant immunotherapy for early-stage NSCLC.
In addition to reducing the risk of cancer recurrence or death, “The treatment was also associated with mostly improved outcomes at surgery, including less extensive surgery, less blood loss and shorter time in the operating room,” says Patrick Forde, principal investigator of the trial, co-director of the upper aerodigestive cancer division at the Johns Hopkins Kimmel Cancer Center and associate member of its Bloomberg~Kimmel Institute for Cancer Immunotherapy.
“We showed — for the first time — that immunotherapy can really improve outcomes when given with chemotherapy before surgery for newly diagnosed stage 1–3 NSCLC. It reduces the relapse rate by almost 40%, meaning that patients in this study, who would have likely gone on to die of lung cancer, may now be cured,” says Forde.“We’re excited by the prospect of adding new therapeutic regimens for this group of patients, who have historically been challenging to treat,” says study co-author Stephen Broderick, associate director of the Johns Hopkins Cardiothoracic Residency Program and a thoracic surgeon who treats patients with lung cancer at the Johns Hopkins Kimmel Cancer Center. “The combination treatment led to no increases in overall toxicity or delays to surgery compared to chemotherapy alone.”