One of the first good news that comes to us from this second virtual edition of the American Society of Clinical Oncology Congress concerns patients with the most common form of lung cancer, non-small cell. The phase 3 CheckMate -9LA study presented today in an oral session, in fact, shows that immunotherapy associated with limited courses of chemotherapy, i.e. two instead of the ‘classic’ four, reduces the risk of death by 28% and by 33% the risk of disease progression. Not only that, 38% of patients who received dual immuno-oncology therapy, consisting of nivolumab plus ipilimumab, in combination with 2 courses of chemotherapy, were alive at two years compared to 26% of those treated with chemotherapy alone. In short, fewer side effects, but more years of life.
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The advantages of the immunotherapy combination
In 2020, almost 41,000 new diagnoses of lung cancer were estimated in Italy, a neoplasm that is particularly difficult to treat, because about 70% of cases are discovered at an advanced stage. And the 5-year survival for people with metastatic non-small cell lung cancer does not exceed 6%. The new therapeutic options, therefore, are of fundamental importance. “The CheckMate -9LA study involved more than 700 patients and has an innovative design,” he explains Cesare Gridelli, Director of the Onco-Hematology Department of the ‘Moscati’ Hospital of Avellino. “First of all, the combination of two immuno-oncological molecules, nivolumab and ipilimumab, allows to obtain a complete and synergistic mechanism of action, because it is directed towards two different checkpoints (PD-1 and CTLA-4)”.
ASCO 2021
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Less chemotherapy and side effects
The further advantage of this therapeutic scheme is represented by the use of limited courses of chemotherapy, which allows to reduce side effects. “This is a great benefit for patients, even from a psychological point of view, because chemotherapy is still scary. The patient, in less than a month, finishes chemotherapy and continues treatment with immunotherapy ”, continues Gridelli.
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The results in metastatic cancer
Dual immuno-oncology therapy in combination with two courses of chemotherapy, at the forefront of metastatic cancer, has shown improvements in both overall and progression-free survival. “In particular, at an extended follow-up of two years, the association continued to show a lasting improvement in overall survival compared to chemotherapy alone, with a median of 15.8 months compared to 11 months,” adds Gridelli. Duration of response also reached 13 months compared to 5.6 months with chemotherapy alone. And these benefits were maintained regardless of the level of PD-L1 expression and histotype, squamous or non-squamous “. Results that seem to confirm the possibility that really lung cancer will soon become the first chemo-free tumor: “They are very promising results”, he comments Saverio Cinieri, president-elect Aiom. “Everything stems from the knowledge of the genome that has allowed us to identify target alterations for lung cancer, from immunotherapy and from the fact that the approach to this type of disease has changed and we hope that it will change more and more. it is rather when it will be available from us because after the approvals in the United States and then by the EMA the times in Italy are still a bit long and we, like Aiom, must work to guarantee access to patients in the shortest possible time “.
The Geriatric Oncology Award
Just today Asco awards Cesare Gridelli with the “BJ Kennedy Award for Scientific Exellence in Geriatric Oncology”, a prestigious acknowledgment that attests to his decisive contribution in the research, diagnosis and treatment of cancer in the elderly. Cesare Gridelli dedicates his reading to the management of advanced non-small cell lung cancer in the elderly patient. The value of the oncologist’s scientific production is evidenced by a very high parameter, which is based on the number of publications and citations received (H-index equal to 69). “The awarding of prizes by Asco to Italians is always a very rare event, so it is an honor for us that this prestigious award goes to Cesare Gridelli”, comments Cinieri.
Prevention has no age
During the presentation of the data from the CheckMate -9LA study, the two oncologists underlined that prevention has no age limit and remains a priority even when one becomes elderly: “We see more and more elderly patients, even those over eighty in splendid shape and a lot also depends on from mental conditions. A few days ago it was World Anti-Smoking Day and it is important to make it clear that it must be considered a risk factor not only for lung cancer but also for physical and mental aging. Smokers are still too many especially among women: we must continue to provide information on these issues for all ages “.
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