Comparing Immunotherapy and Chemotherapy Side Effects in Lung Cancer

In one of the leading medical journals, The Lancet Oncology, a study published in November 2017 found that in non-small cell lung cancer patients treated with the immunotherapy medicine pembrolizumab, quality of lifewas significantly better than with chemotherapy.

New-generation immunotherapies called immune checkpoint inhibitors first received approval in 2011 for the skin cancer malignant melanoma. Immunotherapiesthen rapidly gained approval for more than ten different cancer types, ushering in a new era in cancer medicine.

Immunotherapies treat cancer differently from previously widespread cancer treatments: rather than directly killing cancer cells, they activate the immune system to kill them.

Although many types of immunotherapy have now been identified, the most effective are monoclonal antibodies called immune checkpoint inhibitors. These medicines block cell-surface molecules that cause the immune system to perceive cancer cells as friendly. The best known of these molecules are PD-1, PD-L1 and CTLA4. Nivolumab and pembrolizumab, developed against PD-1, have so far received approval in more cancer types than other immune checkpoint inhibitors; one of these is lung cancer.

Pembrolizumab (trade name Keytruda), which binds PD-1, stage 4 non-small cell lung cancer treatment, both first-line and for patients who have previously received other treatments, has FDA approval .

An ideal cancer treatment should kill cancer cells without harming healthy cells. Because immunotherapies act on cancer cells indirectly through the immune system, they are generally thought to have fewer side effects. However, few studies so far have compared immunotherapy side effects with those of chemotherapy.

• How are the side effects of immunotherapies, the most popular cancer treatments of recent years, managed?

Details of the Study Comparing Immunotherapy and Chemotherapy Side Effects in Lung Cancer

A total of 305 previously untreated patients with lung cancer were randomly divided into 2 groups (154 received pembrolizumab and 151 received platinum-based chemotherapy). The duration of disease control with treatment (progression-free survival) was significantly better in those receiving pembrolizumab.

Alongside treatment effectiveness, patients were compared in terms of side effects and quality of life. Side effects were assessed through cough, chest pain and shortness of breath (dyspnea) as measures.

Unlike many previous side-effect studies, patients in this study completed questionnaires containing questions about their health themselves, using patient-reported outcomes (Patient Reported Outcomes = PRO) software.

The study concluded that pembrolizumab, when given as first-line treatment for PD-L1-positive stage 4 non-small cell lung cancer, promises both greater treatment effectiveness and better quality of life than chemotherapy.