An Important Step in Lung Cancer Treatment: Immunotherapy

Non-small cell lung cancer accounts for almost 85% of all lung cancers. This cancer group consists of different subtypes. It is divided into adenocarcinoma, squamous cell cancer, large cell cancer and other rare subgroups. The most common among these groups is adenocarcinoma, and in recent years there have been encouraging developments in treating this type of fourth-stage lung cancer.

While chemotherapy was the main treatment in this disease group for almost half a century, targeted therapies have now succeeded in taking the leading role, particularly in eligible subtypes of patients with adenocarcinoma, and have moved ahead of chemotherapy in order of preference. However, this applied only to adenocarcinomas, and even in this cancer type, if the individual smoked, eligibility for targeted drugs remained around 20%. Particularly in the last 2 years, new-generation immunotherapies found effective in many cancers have also been found effective in lung cancer treatment. In the initial lung cancer trials, success was found in patients who did not respond after chemotherapy or whose disease progressed during treatment; it was found effective in all subgroups of non-small cell lung cancer and approved by the FDA.

Results of two studies published in the Journal of Clinical Oncology in September 2016 were found extremely promising. In the first study, published by Scott Gettinger and colleagues, the immunotherapy agent Nivolumab was tested as first-line, that is, initial treatment in patients with newly diagnosed lung cancer. Among the 52 patients receiving treatment, 4 achieved a complete response, 8 had significant reduction in tumor size, and 14 achieved stable disease. Side effect data showed the treatment was tolerable, and benefit was observed in 50% of patients. Overall survival was 19.4 months, a promising duration.

In the second study, Naiyer and colleagues this time administered Nivolumab in combination with different chemotherapies in patients with stage 4 newly diagnosed lung cancer, totaling 56 patients. At the end of the study, as expected, side effects were observed at a high rate with the combination of two different treatment strategies. One striking finding was that when nivolumab was combined with the chemotherapy regimen called paclitaxel carboplatin, which we frequently use in lung cancer treatment, it was both more tolerable and 62% of patients lived for 2 years. This is one of the longest average survival periods achieved to date in patients with stage 4 lung cancer.

The results of these two studies we have presented to you are extremely promising. We should remember that these are still preliminary studies and await the results of comprehensive ongoing clinical trials.

In addition, on the basis of these and similar data, studies using these types of treatment strategies will also be initiated in oncology clinics in our country in the coming period. I believe participation in such international studies will benefit our patients. You should ask your treating oncology physicians whether you can be included in ongoing clinical trials of this type.

Note: Two immunotherapy drugs, Nivolumab and Pembrolizumab, have been approved by the FDA after proving effective as second-line treatment in patients with fourth-stage (metastatic) non-small cell lung cancer who did not respond after chemotherapy or whose disease progressed after responding for a certain period. Their use as first-line treatment is not yet appropriate anywhere in the world outside clinical trials. Because these two drugs are very expensive, they have not yet been approved in our country, as in many other countries. In patients whose physician considers their use appropriate, they can be used after obtaining Ministry of Health approval for off-label drug use and with the cost paid by the patient.