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

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