By Dennis Thompson
HealthDay reporter
THURSDAY, May 20, 2021 (HealthDay News) – An immunotherapy drug is the first to significantly reduce the risk of cancer recurrence or death in people with early-stage lung cancer, researchers report.
Atezolizumab reduced the risk of disease recurrence or death by 34% in a certain group of people with stage II to IIIA non-small cell lung cancer – those whose tumors contain a protein that can help malignant cells become recognized by the Immune system eludes new knowledge.
In comparison, standard chemotherapy reduces the risk of future cancer or death by only 16%, the researchers said.
Pending approval by the U.S. Food and Drug Administration for this use, atezolizumab (Tecentriq) could become the standard treatment for patients whose genetics affect the immune system’s ability to detect and kill cancer cells, said lead researcher Dr. Heather Wakelee, chief oncology physician at Stanford University Hospital.
“It’s a more profound benefit than we’ve seen it with chemotherapy, so it would be something for me to offer my patients in this setting,” said Wakelee.
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This clinical trial “is the first time we’ve seen immunotherapy effective in treating early-stage non-small cell lung cancer,” said Dr. Julie Gralow, Chief Medical Officer and Executive Vice President of ASCO. “This is an important advance in understanding the role of immunotherapy in early-stage lung cancer and potentially an advancement for many lung cancer patients.”
According to the American Lung Association, lung cancer is the leading cancer killer in the United States, accounting for a quarter of all cancer deaths. Non-small cell lung cancer accounts for 4 out of 5 lung cancer cases.
Immune checkpoint inhibitors like atezolizumab release the brakes on the immune system designed to prevent an immune response that is so strong that it attacks healthy cells in the body.
In this case, lung cancer is known to use a protein called PD-L1 to evade the immune system. About half of people diagnosed with early-stage lung cancer express PD-L1 on their tumor cells, researchers said in the Supporting Information.
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The PD-L1 protein is typically only present in healthy cells; When white blood cells see the protein on a cancer cell, they are mistaking it for normal and not attacking. Atezolizumab blocks the signal sent by PD-L1 so that the immune cells can recognize the cancer and kill it.
The drug has already shown benefits in the treatment of later stage lung cancer.
The new findings will be presented at the American Society of Clinical Oncology’s annual virtual meeting.
For the study, the researchers recruited 1,280 lung cancer patients whose tumors had been surgically removed and who had undergone chemotherapy. Half were randomly selected to receive atezolizumab while the rest were given supportive care.
Stage II-IIIA non-small cell lung cancer patients with PD-L1 levels of 1% or greater in their tumors responded well to atezolizumab, with a 34% lower risk of recurrence or death compared to controls.
Among all patients with stage II-IIIA lung cancer, those who received atezolizumab had a 21% lower risk of recurrence or death.
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The results represent “the first global phase III study to use an immune checkpoint inhibitor to demonstrate disease-free survival in early-stage non-small cell lung cancer,” said Wakelee.
However, the drug is harsh on patients.
Almost 22% of patients experienced serious to life-threatening side effects compared with 11.5% of those in the control group who received supportive care. Almost 20% of patients had to stop taking atezolizumab due to side effects.
Wakelee said this drug represents an opportunity to save the lives of lung cancer patients if their malignancies are detected in a timely manner.
“It’s important to emphasize that patients need screening to detect lung cancer early if it is potentially curable,” said Wakelee. She added that biopsies and tests should be done to see if people have immune markers like PD-L1, which would make them good candidates for immunotherapy.
The clinical study was funded by the drug manufacturer Roche. Results presented at medical meetings are preliminary until published in a peer-reviewed journal.
More information
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The US National Cancer Institute has more about immune checkpoint inhibitors.
SOURCES: Dr. Heather Wakelee, chief oncology physician at Stanford University Medical Center in Palo Alto, California; Julie Gralow, MD, chief medical officer and executive vice president of the American Society of Clinical Oncology (ASCO); ASCO annual conference 2021, 4-8. June 2021
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