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Lung cancer: Immunotherapy before surgery increases the chances of recovery

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Lung cancer: Immunotherapy before surgery increases the chances of recovery

Immunotherapy can also make a difference in early-stage lung cancer when given before surgery along with chemotherapy. This is demonstrated by the updated data from the 3 CheckMate-816 study just presented at the American Society of Clinical Oncology (ASCO) Congress, which closes today in Chicago. The trial involved 358 patients with resectable non-small cell lung cancer, from stage IB to IIIA, treated with the combination of nivolumab (immunotherapy) and chemotherapy before surgery. In those who no longer showed signs of disease after treatment (complete pathological response), the reduction in the risk of relapse exceeded 80%. Important findings have also been reported for patients with metastatic lung cancer. The three-year CheckMate -9LA data relate to the first-line combination of two immunotherapies – nivolumab and ipilimumab – associated with limited courses of chemotherapy (2 instead of 4 or 6): 27% of patients treated with this approach are alive at three years compared to 19% with chemotherapy alone.

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Immunotherapy for early stage lung cancer

Let’s go in order. What impact can the CheckMate-816 study have? “The findings are really significant and can lead to an early stage change in treatment guidelines,” he replies Federico Cappuzzo, Director of Medical Oncology 2 at the National Cancer Institute ‘Regina Elena’ in Rome. In 2020, in Italy, about 41,000 new cases of lung cancer were estimated, but only about 25% are discovered at an early stage and can be operated on. “To date, surgery is considered the only tool to achieve definitive healing – continues Cappuzzo – but a percentage between 30% and 55% of patients still develop recurrence after surgery, thus confirming a strong need for options. additional. If the surgery is preceded by nivolumab plus chemotherapy, it is possible to obtain an important tumor regression and a potential curability of the patient “. The combination of nivolumab and chemotherapy had already shown a statistically significant improvement in the pathologic complete response rate, achieved by 24% of patients compared to 2% of those treated with chemotherapy alone. “Neoadjuvant chemo-immunotherapy (ie administered before surgery, ed.) Not only reduces the risk of relapse by more than 80% in patients who obtain the complete pathological response, but also increases the number of candidates for surgery”, the oncologist continues: “Today, in fact, patients with locally advanced inoperable disease are treated with chemo-radiotherapy, but the impact of the study is such that it can lead to a change in the care of people with, hitherto excluded from surgery “.

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The combined scheme for metastatic cancer

As for the CheckMate -9LA study, however, the goal is to continue to improve the long-term survival of patients with metastatic disease. The patients received only two courses of chemotherapy, 21 days apart: the chemotherapy, therefore, ends in less than a month, and continues with immunotherapy alone. “It is as if there were two engines, electric and petrol, which work together at the time of departure,” he explains Filippo de Marinis, Director of the Thoracic Oncology Division of the European Institute of Oncology (IEO) in Milan: “In about 30% of patients, in fact, it takes at least 3-4 months for immunotherapy to become effective. With this scheme we can therefore overcome the critical limit of 3-4 months necessary to restart the immune system in some patients, without there being disease progression “. In short, the long-term benefits of immunotherapy add up to the immediate efficacy of chemotherapy in the initial critical phase of stimulation of the immune system. Furthermore, the reduction in the duration of chemotherapy makes treatment more tolerable and improves the patient’s quality of life.

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“CheckMate -9LA – concludes de Marinis – was conducted on more than 700 patients and the data also refer to two subgroups traditionally with poor prognosis, characterized by low expression of the PD-L1 biomarker (less than 1%, ed.) And from squamous histology. In the first case, overall survival at 36 months reached 25% compared to 15% with chemotherapy alone, in the second 24% compared to 11%. Therefore, the value of this therapeutic scheme is strengthened, reimbursed since last January also in Italy ”.

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