Immunotherapy as Neoadjuvant Therapy for Lung Cancer
Researchers at NYP/Columbia have recently launched an important trial of immunotherapy plus chemotherapy as neoadjuvant therapy for patients with locally advanced non-small cell lung cancer (NSCLC). Lung cancer is one of the most common cancers in both men and women worldwide, accounting for 13 percent of newly diagnosed cancers. Approximately 85 percent of all lung cancers are characterized as NSCLC.
In 2015, the first PD-1 pathway inhibitor (an immunotherapy agent) was FDA-approved for treatment of patients with metastatic NSCLC whose disease progressed during or after platinum-based chemotherapy. These checkpoint inhibitors work by “taking the breaks off” the immune system, allowing the immune system to mount a stronger and more effective attack against tumor cells. In general, these drugs are well tolerated, with manageable side effects, and have proven to be less toxic than traditional chemotherapy. The Columbia trial is one of the first to focus on the effectiveness of this approach in patients with locally advanced (non-metastatic) and resectable lung cancer.
“Patients have read about the promise of immunotherapy, and they are eager to try this approach,” says Catherine Shu, MD, the principal investigator at Columbia. “But at the moment, these PD-1/PD-L1 inhibitors are only available for those with Stage 4 metastatic disease. This trial is a way for patients with earlier stage disease to have access to immunotherapy.”
The goal of this study is to see whether or not the combination of immunotherapy plus chemotherapy can improve the response rate over patients receiving chemotherapy alone. The plan for all patients is to proceed to surgery after this induction treatment. Patients enrolled in this trial will receive nab-paclitaxel + carboplatin + atezolizumab (PD-1 checkpoint inhibitor). A full description of this trial can be found here https://clinicaltrials.gov/ct2/show/NCT02716038