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Study: Value Of Chemotherapy Post Immunotherapy In Stage IV Non-small Cell Lung Cancer

A new research paper was published in Oncotarget, titled "Value of chemotherapy post immunotherapy in stage IV non-small cell lung cancer (NSCLC)."

Lung cancer is the number one cause of mortality among all types of cancer worldwide. Its treatment landscape has shifted from the classic chemotherapy alone to newer regimens based on the discovery of new immunotherapy and targeted therapy drugs. However, chemotherapy is still an option for treatment of advanced non-small cell lung cancer (NSCLC) after progression on immunotherapy alone or in combination with first-line chemotherapy.

This new retrospective study, by researchers Hazem I. Assi, Maroun Bou Zerdan, Mohammad Hodroj, Makram Khoury, Nour Sabiha Naji, Ghid Amhaz, Reine Abou Zeidane, and Fadi El Karak from the American University of Beirut Medical Center and Hotel Dieu de France University Hospital, was based on chart review of patients diagnosed with advanced NSCLC cases who received Docetaxel as second or third line after being treated by immunotherapy and/or chemotherapy in previous lines.

The data was collected from the medical records of physicians' clinics in three different hospital centers in Lebanon over the period of 5 years from July 2015 until December 2020. February 2021 was data analysis cut off time.

Credit: Impact Journals LLC

"The main aim [of this study] was to assess the role of Docetaxel post-chemoimmunotherapy for patients with diagnosed NSCLC," say the researchers.

A total of 21 patients were included in this study. The majority of our patients were males (81%). As for histologic type, most patients had non-squamous lung cancer (67%) as compared to 33% who had squamous lung cancer. Overall, their study reported a 24% response rate to Docetaxel including stable disease and partial response and a median progression free survival (PFS) of 3 months. The mean time interval elapsed from diagnosis to the initiation of Docetaxel was 11.5 months.

"New therapeutic options should be validated for the treatment of NSCLC in the second and subsequent lines of therapy considering the poor prognosis of this disease. The chemotherapy in second and third line may keep an important role in the treatment after progression on newer agents, but it needs more evidence in prospective studies including a larger number of patients," say the researchers.

More information: Hazem I. Assi et al, Value of chemotherapy post immunotherapy in stage IV non-small cell lung cancer (NSCLC), Oncotarget (2023). DOI: 10.18632/oncotarget.28444

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Curative-Intent Treatment Improves Survival In Early NSCLC Regardless Of Race

Curative-intent therapy in patients with early non-small cell lung cancer resulted in "nearly identical survival" for Black and White individuals.

Curative-intent treatment for early-stage non-small cell lung cancer (NSCLC) yielded comparable survival rates in non-Hispanic Black and non-Hispanic White individuals, according to findings presented at the 2023 ASCO Annual Meeting.

"Racial disparities in early-stage NSCLC survival have persisted between [Black patients] and [White patients] in the past few decades," Paulo S. Pinheiro, PhD, and colleagues wrote. "The role of receipt of curative-intent surgery and/or stereotactic body radiation therapy (SBRT) in this disparity is unclear."

To investigate this question, Dr. Pinheiro and colleagues assessed associations of race/ethnicity and curative-intent treatment (surgery and/or SRBT) with mortality among individuals with early-stage NSCLC using population-based data from Florida, "the third largest state in the US and the second state in the number of cancer cases diagnosed annually," according to the study results.

The researchers examined all patients in the state with a diagnosis between 2007 and 2018 according to racial/ethnic group: non-Hispanic Black (NHB), Hispanic, Asian/Pacific Islander (API), and non-Hispanic White (NHW). Multivariable Cox proportional hazards regression models were used to examine the association of race/ethnicity and curative-intent treatment with lung cancer-specific mortality.

The analysis included data from 63,872 patients with early-stage NSCLC (83.2% NHW; 8.7% Hispanic; 6.6% NHB; 0.79% other races; and 0.77% API). Most patients (72.2%) received curative-intent therapy in the form of surgery or SRBT, or both. Median lung cancer-specific survival for all patients was 5.43 years.

After inclusion of all clinical and sociodemographic factors, such as stage at diagnosis and comorbidities, race/ethnicity (NHB vs NHW: HR, 1.06; 95% CI, 1.00-1.11) and curative-intent treatment (SBRT vs surgery: HR, 1.87; 95% CI, 1.78-1.97) were independently associated with lung cancer-specific mortality. However, after combining the effect of race/ethnicity and curative-intent treatment in the fully adjusted model, NHB patients who received curative-intent therapy had "nearly identical survival" compared with NHW patients (HR, 0.95; 95% CI, 0.87-1.03), according to the study results. Similar findings were seen in a competing risk analysis (subdistribution HR, 0.97; 95% CI, 0.89-1.02).

"The results underscore the importance of considering receipt of (specifically) curative-intent treatment rather than receipt of any form of surgery or radiotherapy in racial/ethnic survival disparities," Dr. Pinheiro and colleagues wrote. "The uptake of curative-intent surgery and SBRT, which currently stands at 56.5% and 9.4%, respectively, should be increased to improve survival outcomes for early-stage NSCLC for all."

New Treatment Option For Metastatic Colorectal Cancer Prolongs Survival

image: Cathy Eng, MD, the David H. Johnson Professor of Surgical and Medical Oncology, professor of Medicine at Vanderbilt University Medical Center and co-leader of the Gastrointestinal Cancer Research Program at Vanderbilt-Ingram Cancer Center, led the international trial as co-principal investigator. She is also the lead senior author of the study published in The Lancet. View more 

Credit: Vanderbilt University Medical Center

A new therapy is on the horizon for patients with metastatic colorectal cancer who have run out of treatment options.

Results from an international clinical trial, published June 15 in The Lancet, show that the selective targeted therapy,  Fruquintinib, resulted in a statistically significant improvement in overall survival and progression-free survival.  Patients who received Fruquintinib had a median survival rate of 7.4 months compared to 4.8 months for patients who received placebo plus best supportive care and progression-free survival of 3.7 months vs. 1.8 months. Participants who received fruquintinib had a 34% reduction in death compared to the placebo group. At six months, 24% of patients on fruquintinib were progression free versus 1% on placebo.

The FRESCO-2 clinical trial for fruquintinib was conducted at 124 sites across 14 countries. The study recruited patients with metastatic colorectal cancer who had not responded to other treatments and who had received a median of four prior lines of therapy.

Cathy Eng, MD, the David H. Johnson Professor of Surgical and Medical Oncology, professor of Medicine at Vanderbilt University Medical Center and co-leader of the Gastrointestinal Cancer Research Program at Vanderbilt-Ingram Cancer Center, led the international trial as co-principal investigator. She is also the lead senior author of the study published in The Lancet.

"The majority of stage IV patients will have surgically unresectable disease.  Hence, we must continue to pursue new treatment options to extend the overall survival of our patients with quality of life. These findings from international FRESCO-2 validated the findings of the phase III FRESCO trial which was conducted only in China.  Here we have a promising agent with overwhelming single agent activity.  I look forward to the FDA approval as well as approvals from the European Medicines Agency and the Pharmaceuticals and Medical Devices Agency in Japan, so we can offer Fruquintinib to all metastatic colorectal cancer patients," said Eng.

The proportion of patients who were still alive at nine months was 41% in the fruquintinib group and 28% in the placebo group. The median duration of response for fruquintinib was 10.7 months. Some patients were super responders. The maximum duration of response by a patient was ongoing at 16.9 months.

The trial involved 691 patients, who were assigned by a 2:1 ratio to either receive fruquintinib or placebo. The fruquintinib arm numbered 461, while the placebo group numbered 230.

Fruquintinib is an oral medication that selectively targets and inhibits vascular endothelial growth factor receptors (VEGFRs 1,2, and 3), which regulate the development of new blood vessels associated with tumor growth and cancer metastasis. The U.S. Food and Drug Administration (FDA) in June 2020 granted Fruquintinib fast track designation, and on March 31, the pharmaceutical company with the U.S. Licensing rights formally submitted the new drug application to the FDA. The study published in The Lancet is the final efficacy analysis of fruquintinib from the FRESCO-2 trial.

Currently, there is a paucity of approved effective treatments in the U.S. For metastatic colorectal patients who have progressed on standard treatments, demonstrating the unmet need for new treatment options.

The updated analysis as of the Annual ASCO Meeting 2023 demonstrated that the FRESCO-2 trial showed that Fruquintinib was well tolerated by patients. The most frequent adverse events leading to dose reduction were hand-foot syndrome (3%), hypertension (3.3%). Overall, fewer than 0.5% of all patients discontinued therapy due to a treatment related toxicity. 

Improvements with Fruquintinib were seen regardless of treatment with prior therapies in the heavily pretreated patients who participated in the clinical trial. Approximately 50% of patients with colorectal cancer will develop distant metastases, and the five-year overall survival rate for these patients is only 15%.

Article Publication Date

15-Jun-2023

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