There's a New Standard of Care for Lung Cancer

How many people have fully wrapped their heads around the recent change in the standard of care for advanced lung cancer? This change has rolled out bit by bit since May of 2015 (less than two years ago!) with FDA approvals of three new drugs, and now includes nearly all types of lung cancer. It’s part of the National Comprehensive Cancer Network (NCCN) guidelines for care, which means oncologists should know about it, and insurance companies should pay for it without a fight. When I look at the short amount of time in which this change has happened and the number of lung cancer patients who are potentially affected, it seems to me that this really is big, big news.

I’m talking about the newest innovative treatment for lung cancer - immunotherapy.

It doesn’t work for everyone - in fact, it won’t work for most of us. No one treatment yet does, probably no one treatment ever will. But 40% of patients with non-small cell lung cancer respond for a while, and 20% respond for a long time. Even trials with small cell lung cancer patients have shown enough response so that immunotherapy is now included in NCCN guidelines as a possible second line treatment. These statistics might seem disappointing, but they are a lot better than the other second-line chemotherapy drugs available to us.

The side effects can be very serious, including pneumonitis and auto-immune reactions. If you decide to try immunotherapy, you’ll need to be vigilant and to know when to call your doctor, and your doctor needs to prepare to handle a wide range of possible complications. An in-depth discussion is obviously in order between you and your doctor so that you make sure that you are both ready for this new and different lung cancer treatment. 

Researchers are still working to improve these drugs. The current thinking is that they will work even better in combination with other lung cancer treatments, including other drugs, chemotherapy, and radiation therapy. There are many, many clinical trials happening right now that are testing various combinations. By the end of the decade, we are going to know a lot more about the best way to use immunotherapy drugs.

Who can use immunotherapy? 
- All newly diagnosed non-small cell lung cancer patients not eligible for targeted treatment if they have enough PD-L1 biomarker. (FDA approved!)
- All non-small cell lung cancer patients after initial treatment with either platinum-based chemotherapy or targeted therapies. (FDA approved!)
- Small cell lung cancer patients after initial treatment, per NCCN guidelines. This is not FDA approved yet, so expect some discussions with your doctor and your insurance company if you want to try this new class of drugs.

One group of patients who will want to approach immunotherapy with caution are those with targetable mutations - EGFR, ALK and ROS1. I attended the Targeted Therapies in Lung Cancer Patient Forum in Denver, CO, in August 2016, and the doctors there said that analysis of data from drug trials shows a lower rate of response to these new drugs in EGFR patients. They strongly suggested that this group of lung cancer patients should use chemotherapy first before using immunotherapy drugs.

It’s not a miracle or a cure, but immunotherapy puts a healthy serving of HOPE on the table for nearly all of us. I know several lung cancer patients who have already benefited from these drugs, in some cases showing a remarkably good response. As I think about everything that has happened this year, I put this new standard of care firmly in the category of “good news”.


Link to my chart of FDA approvals of immunotherapy drugs at end of 2016:
https://docs.google.com/spreadsheets/d/1HIUkKJiiHXVxxANgh8s-ikNCRFvVqsX4Zj8YEVrBCO4/pubhtml?gid=0&single=true

 Sources:
“Hematology/Oncology (Cancer) Approvals & Safety Notifications”, FDA, http://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm279174.htm
“Nivolumab alone and nivolumab plus ipilimumab in recurrent small-cell lung cancer (CheckMate 032): a multicentre, open-label, phase 1/2 trial”, PubMed.gov. https://www.ncbi.nlm.nih.gov/pubmed/27269741

 Photo is in the public domain.
Source: National Cancer Institute/Duncan Comprehensive Center at Baylor College of Medicine
Creator: Rita Elena Serda

Comments

  1. WizenedWizardDecember 29, 2016 at 5:16 PM

    Well researched and written, Anita. You are a guiding light for other patients.

    ReplyDelete

Post a Comment

Please support the EGFR Resisters Research Fund!

To help improve outcomes for people like me with EGFR mutated lung cancer, please donate to the EGFR Resisters' Research Fund. All donations are tax deductible and are in a restricted fund with the Bonnie Addario Lung Cancer Foundation, a four-star rated charity. Thank you from the bottom of my heart!


Popular posts from this blog

I am not a rock. I am not an island.

Image
After a busy couple of months, I have retired, and I am under treatment. The treatment is a pill taken first thing in the morning. The medicine is very expensive, to all of us in the aggregate although not to me as an individual. Thank goodness for good health insurance. I do have a genetic mutation in the cancer and am able to take targeted treatment. I’m dealing with some side effects, but they aren’t as uncomfortable as full-bore chemo. I’ve been taking care of business. New wills and powers of attorney are executed, my passwords are in a sealed envelope in the lawyer’s safe, beneficiaries are updated, and expenses have been dialed back. I finished my job as neatly and completely as possible, and left matters in good shape for my successor. All of this is liberating. As each task gets done, there is more time to simply enjoy living. I am an oldest child, and I’ve spent much of my life being a responsible person. Now I am pulling back from that role. At the moment, I have very few re...
Read more

Why I am Using Research-Based Medical Treatments Instead of Naturopathic Treatments

Image
I’ve heard many stories of people being sent links to websites promoting alternate naturopathic treatments for cancer by well meaning friends and family. It finally happened to me. I got an email from an acquaintance who told me she believed that I was making a mistake signing up for a clinical trial, and that I should be using natural treatments based on diet and supplements such as turmeric and IV vitamin C. She quoted the saying “Let Food be your Medicine”, and pointed me towards the website thetruthaboutcancer (no, I am NOT going to link to that site from my blog, it gets enough traffic). She also told me that I was signing up to be a guinea pig. This blog post has been in the works in my thoughts ever since. I do not think that this good-hearted person is on the right track, and sincerely hope that, for her sake, she never develops cancer and never has to put her alternate treatments to the test. In thinking about what she said, however, I finally crystallized for myself the reaso...
Read more

My Carbon Footprint Grows Ever Larger

Image
This is how I would reword Shakespeare: Nothing offends me about my life so much as the manner of my leaving it. It’s not the disease, or the timing that makes me feel that way. It’s the staggering amount of energy that is consumed as part of cancer care - energy in the form of miles driven and plastic tossed into a biowaste disposal canister. I haven’t lived an exemplary life when it comes to the amount I have contributed to landfills. I’m not even good about composting my food waste. Still, getting sick has enlarged my carbon footprint, and I’m not done yet. There’s the matter of how to dispose of my mortal remains, for one thing, plus I’m not done with blood draws and treatments. Take the simple matter of a blood draw. Initially they were all taken from a vein. Waste generated: an alcohol wipe, a rubber tourniquet, a pair of gloves, a butterfly needle with attached plastic tube, a few glass vials, and a couple of pieces of gauze topped with a bandaid. Now, however, I ...
Read more