Immunotherapy Holds Promise in Lung Cancer
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GENEVA — Lung cancer researchers continue to be excited over the potential for immunotherapy, and the subject was given a top billing here in a keynote lecture on the first day of the European Lung Cancer Conference 2014.
Reviewing early clinical data with several investigational immunomodulatory drugs that have been tested in advanced lung cancer, Julie Brahmer, MD, MSc, associate professor of oncology at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, said the results show a similar pattern for all the new agents. About 20% of patients respond to these therapies, and the responses are durable, even when the drug is stopped.
The investigational drugs include nivolumab (Bristol-Myers Squibb) and MK-3475 (Merck & Co.; now known as pembrolizumab and formerly known as lambrolizumab), which act as programmed death inhibitors, and also BMS-936559 and MPDL-3280A (Genentech/Roche), which are antiprogrammed-death ligand inhibitors. Although they act at slightly different points, they both function as checkpoint inhibitors in the interaction between T-cells and cancer cells.
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Dr. Julie Brahmer
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In an interview with Medscape Medical News, Dr. Brahmer predicted that "for the immunomodulatory agents that are being tested in lung cancer, there is a subset of patients who will be able to be treated and have their disease controlled for a long period of time, but we have yet to find a way of identifying those patients, other than to try them on the drug to see if they respond."
"Most of the patients who are benefiting are benefiting for a long period of time, and their disease does not seem to be progressing," Dr. Brahmer said.
She mentioned 2 patients in her clinic who are still alive 3 years after starting on nivolumab in a clinical trial; these were patients who had progressed on several previous therapies, with an expected survival of around 4 to 6 months.
Similar extended survival in lung cancer has been seen recently in patients with EGFR mutations treated with targeted agents such as erlotinib (Tarceva) or gefitinib (Iressa), she said, but in those cases, the patients continue on the therapy, and they eventually become resistant to it.
With these new immunomodulators, the response persists even when patients stop taking the therapy, and has been seen even in patients who have taken only 1 dose of the drug. This suggests that there has been some resetting of the immune system, perhaps creating some sort of immune memory, she said.
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