Immunotherapy Changing Outcomes for Lung Cancer Survival

One of the biggest concerns for cancer patients is that their tumor will return or begin growing again. This fear is also relevant for lung cancer and mesothelioma patients.

Fortunately, immunotherapy and other targeted therapies are reducing the rates of recurrence for many lung cancer patients and improving survival rates.

The 5-year lung cancer survival rates increased by 21% — from 21% in 2014 to 25% in 2018, according to the 2022 State of Lung Cancer Report published by the American Lung Association. While this is an incremental change, it’s a major step forward.

“A 21% increase in five-year survival is good, said Dr. Jeffrey Crawford, a medical oncologist at Duke University Health. “I don’t think there are too many other groups that have seen that level of improvement.”

As part of Lung Cancer Awareness Month, the Mesothelioma Guide staff is publishing a series of blogs about lung cancer incidence, screening, and new treatment options. This article focuses on the power of immunotherapy for lung cancer and how immunotherapy is preventing lung tumors from returning. This is important for all lung cancer patients, even those with lung cancer from asbestos.

 

FDA-Approved Immunotherapy for Lung Cancer

The U.S. Food and Drug Administration has made approving immunotherapy drugs a priority for lung cancer due to the high incidence. More than 230,000 people in the U.S. each year are diagnosed with lung cancer, and the 5-year survival rate is only 23%.

Immunotherapy treatments for lung cancer include immune checkpoint inhibitors, EGFR- and VEGF-targeted therapies and monoclonal antibodies.

A report from CNN credits EGFR-targeted therapies for improving the life expectancies of lung cancer patients with specific EGFR mutations. The life expectancy for this segment of lung cancer patients is more than four years.

The FDA-approved immune checkpoint inhibitor treatments for non-small cell lung cancer are:

• Atezolizumab (Tecentriq)
• Cemiplimab (Libtayo)
• Durvalumab (Imfinzi)
• Ipilimumab (Yervoy)
• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)
• Tremelimumab (Imjudo)

The monoclonal antibodies for non-small cell lung cancer are:

• Amivantamab
• Brigatinib
• Necitumumab

The targeted therapies for non-small cell lung cancer are

• Afatinib dimaleate
• Capmatinib
• Crizotinib
• Dabrafenib
• Gefitinib
• Lorlatinib
• Osimertinib
• Pralsetinib
• Sotorasib
• Tepotinib
• Trametinib

Latest Approved Immunotherapies for Lung Cancer

The latest FDA approval of immunotherapy for lung cancer occurred last week. The agency approved durvalumab (Imfinzi) and tremelimumab (Imjudo). The combination is approved with chemotherapy for stage 4 non-small cell lung cancer cases.

Patients who received this regimen of immunotherapy and chemotherapy had a 23% reduction in risk of death. Nearly 33% of patients were alive at least two years versus just 22% of patients receiving only chemotherapy.

Imfinzi is also approved to treat stage 3 non-resectable non-small cell lung cancer and extensive-stage small-cell lung cancer.

The FDA also approved nivolumab (brand name Opdivo) in March of 2021. This was the most recent approval of immunotherapy for lung cancer.

FDA Approval of Cemiplimab

The FDA approved an immune checkpoint inhibitor, called cemiplimab, to treat non-small cell lung cancer in February of 2021. The FDA recently approved cemiplimab with chemotherapy as a first-line treatment. This means people with non-small cell lung cancer don’t have to try another type of treatment before receiving this immunotherapy. This is the most common type of lung cancer, so the approval helps hundreds of thousands of people.

Cemiplimab is sold under the brand name Libtayo. The checkpoint inhibitor led to a median overall survival of 22 months, and the 1-year survival rate was 66%. These figures are much better than the overall averages for all patients with lung cancer.

 

Immune Checkpoint Inhibitors for Lung Cancer

Immune checkpoint inhibitors are a type of immunotherapy that blocks the interaction between two proteins: one on cancer cells and one on immune cells. Cemiplimab blocks the proteins PD-1 (immune cells) and PD-L1 (cancer cells).

When these two proteins interact via protein receptors on the surface of the cells, PD-L1 tells PD-1 to shut down the immune cell’s response to cancer. PD-L1 is considered an “immune checkpoint”, which is why cemiplimab is called an “immune checkpoint inhibitor.”

Other immune checkpoint inhibitors approved for non-small cell lung cancer – atezolizumab, durvalumab, nivolumab and pembrolizumab – inhibit the same cancer cell protein: PD-L1. Durvalumab was the first immune checkpoint inhibitor approved for lung cancer.

Ipilimumab and tremelimumab, also approved for lung cancer, are other immune checkpoint inhibitors but target a different set of proteins. They block CTLA-4 and B7 from interacting. Ipilimumab (brand name Yervoy) is often combined with Opdivo to treat different types of cancer. Tremelimumab (brand name Imjudo) is combined with durvalumab (Imfinzi).

 

Recent Studies Highlight Lung Cancer Survival From immunotherapy

A couple of recent studies pinpoint the benefit of immunotherapy for lung cancer survival. An article published on MedPageToday noted that pembrolizumab led to a 5-year overall survival of 32%. This survival rate was double that of patients receiving chemotherapy.

The median survival was also nearly twice as high for immunotherapy patients: 26.3 months versus 13.4 months.

A different study of 20 surgery patients highlighted how immunotherapy helps before surgery. The New England Journal of Medicine paper specified that non-small cell lung cancer patients received immunotherapy before surgery and 45% (9 of 20) had a positive tumor response.

Using Immunotherapy Before Other Therapies

In a study of non-small cell lung cancer patients, immune checkpoint inhibitors worked as a first-line therapy. They improved the outcomes for patients receiving ramucirumab (VEGF-targeted immunotherapy) and docetaxel (chemotherapy).

Around 100 patients received an immune checkpoint inhibitor followed by this combination of immunotherapy and chemotherapy. The disease-control rate was nearly 75%.

 

Lung Cancer Surgeon Explains Evolution of Treatment

Dr. Benny Weksler is the professor of cardiothoracic surgery at Drexel University College of Medicine, system chief of thoracic surgery for Allegheny Health Network (AHN), and chief of the division of thoracic surgery in the department of cardiothoracic surgery at Allegheny General Hospital. He spoke with the website Targeted Oncology about the way lung cancer treatment has evolved – and still is evolving.

Dr. Weksler said the monumental change occurred with a clinical trial of patients with unresectable stage 3 non-small cell lung cancer. The patients received chemotherapy and immunotherapy prior to immunotherapy. The immunotherapy in the study was durvalumab, which is a checkpoint inhibitor that blocks the protein receptor PD-1 and PD-L1. Using immunotherapy even helped people with stage 4 non-small cell lung cancer.

“As a surgeon, I’m never that excited with diseases that we can’t cure, but the results for stage IV disease are impressive,” Dr. Weksler said. “In some patients who have lung cancer, it becomes like a chronic disease that is getting treated, and the cancer is in check. Now we see patients with stage IV disease surviving over 4 or 5 years, and that’s something that never happened before. Before, 2-3 years survival was the norm for patients with stage IV disease.”

He added that the most progress occurred for patients with stage 1B to stage 3B lung cancer and even for patients who had surgery before or after immunotherapy. The benefit is a reduced risk of the disease returning after resection.

For more information on the evolution of lung cancer treatment, visit the Lung Cancer Research Foundation. This non-profit organization is also an opportunity to donate towards lung cancer research during Lung Cancer Awareness Month.

If you’d like more information on lung cancer treatment options, email our registered nurse Karen Ritter at karen@mesotheliomaguide.com to begin a conversation.