A new first-line combination therapy for advanced non-squamous non-small-cell lung cancer improved progression-free survival during a Phase III trial.

Scientists based at the Lung Clinic Grosshansdorf, Hamburg, and Centre Hospitalier Universitaire Vaudois, Lausanne, have presented the results of a Phase III study at the ESMO Immuno Oncology Congress 2017. The study was the first to investigate a combination of chemotherapy, anti-angiogenic treatment, and immunotherapy as a first-line treatment for advanced lung cancer. The triple therapy combination significantly increased progression-free survival in cancer patients.

Non-squamous non-small-cell lung cancers (NSCLCs) include adenocarcinoma, squamous cell cancer, and large cell carcinoma, which make up around 87% of lung cancer cases in the UK. Treatment options include surgery, chemotherapy, and radiotherapy, but the time of diagnosis is key, as once the cancer has spread, chances of survival drop to less than 20%In 2014, there were over 46,000 new cases and almost 36,000 deaths from the disease in the UK alone.

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To try and improve the survival rate, a triple combination therapy was put together, with the hope that the components would synergize against the disease. Bevacizumab, an inhibitor of vascular endothelial growth factor-related immunosuppression, was proposed to enhance the ability of atezolizumab, a monoclonal antibody that inhibits programmed death-ligand 1 (PD-L1) to restore anti-cancer immunity. Chemotherapy would then be able to induce a strong immune response, no longer hindered by blocks put in place by the PD-L1 checkpoint inhibitor.

The combination of atezolizumab, bevacizumab and chemotherapy improved progress-free survival. However, despite statistical significance, an improvement in median progression-free survival from 6.8 months to 8.3 months in comparison with bevacizumab and chemotherapy alone does not sound too impressive, meaning it may not be worth a potentially huge price tag. We will see if overall survival data is more convincing, with the group buoyed by encouraging early signs.

Elsewhere, Transgene and Bristol-Myers Squibb are also working on a combination therapy for lung cancer, combining a checkpoint inhibitor with a vaccine, which has been cleared to begin Phase II by the FDA. Last year, MedImmune looked to combine two checkpoint inhibitors to treat lung cancers irrespective of their PD-L1 status.

With a number of different combination therapies being tested for lung cancer, the next challenge is to pick out the best one. Combining all our best treatments may sound like a good idea, but it is worth considering the strain that the patient’s body and wallet will be placed under and whether this offsets potential benefits.


Media – tadamichi / shutterstock.com; Cancer Research UK

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