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Immunotherapy has changed the way of the treatment of cancer.
FREMONT, CA: There was a time when chemotherapy was the only treatment option for metastatic non-small cell lung cancer (NSCLC). But a few years ago, immunotherapy—treatment that boosts a patient’s immune system to fight cancer, came into being. Today, new immunotherapy alternatives continue to alter the NSCLC treatment landscape.
While some NSCLC tumors have vital molecular features, like mutations in the EGFR or ALK genes—that drive the tumor formation and target specific drugs, many do not. Immunotherapy offers a potentially robust tool contrary to NSCLC tumors without the “druggable” mutations.
The first FDA-approved immunotherapy for non-small cell lung cancer, nivolumab, is an immune checkpoint inhibitor (ICI). This drug triggers the immune system’s T cells to target the cancer cells. Currently, the FDA has approved a complete of four ICI drugs for NSCLC. These include two “anti-PD-1” drugs, pembrolizumab (Keytruda), and the nivolumab (Opdivo), which will work by targeting an immune system protein known as PD-1, one “anti-PD-L1” drug, atezolizumab (Tecentriq), which activates the protein PD-L1. A fourth ICI, “anti-CTLA4” drug ipilimumab (Yervoy), has just been FDA-authorized for NSCLC in mergers with nivolumab.
In the year 2016, pembrolizumab became an FDA-approved option for first-line treatment. However, as a single drug, pembrolizumab is now suggested only for patients with high levels of PD-L1 protein in the tumors. Atezolizumab was authorized on May 18, 2020, only for the patients with PD-L1 expression in over 50 percent of their tumor cells. Overall survival witnessed with this drug in a clinical trial was 20 months instead of 14 months with chemotherapy.
Moreover, the response rate (percentage of patients who experience a benefit) for ICI drugs on their own is not high, so treatments combining ICIs with other drugs have been tested in numerous trials. In under two years, the preferred first-line treatment for NSCLC has mostly shifted from a single ICI to the combination of ICIs with chemotherapy. In March of this year, The American Society of Clinical Oncology and Ontario Health released new guidelines for first-line NSCLC treatment that practically mandate combining chemotherapy with ICIs (with some exceptions, such as for patients with high PD-L1 levels or low ability to perform everyday activities).