23 cancer research highlights from the past year

A New Era In Small Cell Lung Cancer Treatment

Dr. Debu Tripathy, editor-in-chief of CURE magazine, discusses the advancements made in small cell lung cancer.

Dr. Debu Tripathy, editor-in-chief of CURE magazine

Although advancements in treatments for small cell lung cancer (SCLC) are scarce for this aggressive cancer type, recent regulatory developments and trial results indicate that we are on the precipice of a new era for patients and providers alike.

We put a spotlight on these big steps forward and discuss what they mean for the future of SCLC treatment in this seasonal issue of CURE.

"The limited options of treatment for patients with small cell lung cancer is the reality that we all confront — but that is not for lack of trying," said Dr. Taofeek K. Owonikoko, executive director of the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center in Baltimore.

However, a glimmer of hope emerged with the approval of Imdelltra (tarlatamab-dlle) by the Food and Drug Administration (FDA) in May 2024 to treat patients with extensive-stage (ES) SCLC.

This groundbreaking immunotherapy, known as a bispecific T-cell engager therapy, offers an innovative approach to treating SCLC. Imdelltra works by binding to both cancer cells and immune cells, bringing them close together, which activates the immune system to attack and destroy the tumor.

Elsewhere this year, results of the landmark phase 3 ADRIATIC trial of Imfinzi (durvalumab), an immunotherapeutic antibody known as a checkpoint inhibitor, attracted plenty of attention in discussions at the American Society of Clinical Oncology Annual Meeting. The findings have also been published in the Journal of Clinical Oncology.

Imfinzi, which was initially approved by the FDA in 2020 in combination with etoposide and either carboplatin or cisplatin as first-line treatment of ES-SCLC, was tested in ADRIATIC in patients with limited-stage (cancer on one side of the chest only) SCLC and whose disease had not progressed after chemoradiotherapy.

"This is perhaps the only breakthrough advancement in the past 30 years, because we have been using chemotherapy and radiation to treat [patients with] limited-stage small cell lung cancer since more than 30 years ago. However, this is the first time a new treatment has been shown to be able to prolong life for almost two years," said Dr. Yuanbin Chen of the Cancer and Hematology Centers in Grand Rapids and Norton Shores, Michigan.

Imfinzi blocks the immune-dampening protein PD-L1, thereby helping the immune system detect and attack cancer. Based on the results of the ADRIATIC trial, the FDA has accepted a supplemental biologics license application for Imfinzi and granted priority review, with a regulatory decision expected later this year.

In discussing these developments, we also delve into the side effects associated with these treatments and acknowledge the continued need for a cure for SCLC — one of the more virulent cancers.

"We're still far, far away from where we need to be, which is, how do we transform cancer from being a very mortal diagnosis to something that people can survive?" said Owonikoko.

For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.

Doctors May Have Found The Best Way To Keep Lung Cancer Patients From Dying

(Photo by Anna Tarazevich from Pexels)

BALTIMORE — In a world where cancer remains a formidable foe, a glimmer of hope has emerged for those battling non-small cell lung cancer. A recent analysis by researchers at the Johns Hopkins Kimmel Cancer Center has unveiled a potential paradigm shift in treatment strategies that could significantly improve patients' chances of survival.

The study, which will be presented at the International Association for the Study of Lung Cancer 2024 World Conference in San Diego, suggests that patients may benefit substantially from receiving immunotherapy treatments both before and after surgery, rather than just before.

"There's been a big migration in lung cancer and in melanoma treatment in the last few years from doing surgery upfront and giving postoperative immunotherapy, to giving immunotherapy prior to surgery. But our analysis in individual patients in these two trials suggests that there is likely a further benefit from receiving additional immunotherapy treatment after surgery," explains Dr. Patrick Forde, an adjunct professor of oncology at the Johns Hopkins University School of Medicine, in a media release.

This revelation comes at a time when the medical community has been increasingly focused on harnessing the power of the body's immune system to fight cancer. Immunotherapy, a treatment that helps the immune system recognize and attack cancer cells, has shown promising results in various types of cancer, including lung cancer.

The researchers compared two groups of patients: one that received immunotherapy only before surgery, and another that received it both before and after. Patients who received at least one dose of the immunotherapy drug nivolumab after surgery showed a 40% reduction in the risk of their cancer coming back or death.

What does this mean for patients?

Imagine your immune system as a highly trained army. Immunotherapy before surgery is like sending in a special forces team to weaken the enemy's defenses. Adding immunotherapy after surgery is like deploying reinforcements to mop up any remaining resistance and prevent the enemy from regrouping.

Interestingly, the benefits of this extended immunotherapy approach were seen across different patient groups. Whether patients had early or advanced stages of cancer, they showed similar improvements. Even more intriguing was the observation that patients whose tumors had lower levels of a protein called PD-L1 – which usually helps cancer cells evade the immune system – seemed to benefit more from the extended treatment.

This finding challenges the conventional wisdom that patients with lower PD-L1 levels might not respond as well to immunotherapy. It suggests that even patients who were previously thought to be less ideal candidates for immunotherapy could potentially benefit from this approach.

Moreover, the extended immunotherapy regimen proved beneficial even for patients who didn't achieve a complete response to the initial treatment before surgery. This offers hope to a broader range of patients, including those who might not have seen optimal results from pre-surgical treatment alone.

For patients facing the daunting prospect of lung cancer surgery, this study offers a ray of hope – a possibility that their own immune system, with a little extra help, could be the key to a cancer-free future.

Paper Summary Methodology

The researchers conducted a comparative analysis of two clinical trials: CheckMate 816 and CheckMate 77T. In the first trial, 147 patients received three cycles of immunotherapy (nivolumab) plus chemotherapy before surgery. In the second trial, 139 patients received up to four cycles of the same combination before surgery, followed by up to 13 cycles of nivolumab after surgery. The health outcomes of these patients were tracked for up to four years after their surgeries.

Key Results

The analysis revealed a 40% reduction in the risk of cancer recurrence or death among patients who received at least one dose of nivolumab after surgery, compared to those who only received treatment before surgery. This benefit was observed across different cancer stages and was particularly pronounced in patients with lower levels of PD-L1 expression in their tumors.

Discussion & Takeaways

The study suggests that extending immunotherapy treatment to both before and after surgery could significantly improve outcomes for patients with operable non-small cell lung cancer. This approach appears to be beneficial even for patients who don't achieve a complete response to pre-surgical treatment, potentially broadening the group of patients who could benefit from immunotherapy. The findings challenge some existing assumptions about immunotherapy effectiveness based on PD-L1 levels, opening new avenues for treatment strategies.

Funding & Disclosures

The clinical trials referenced in this study (CheckMate 816 and CheckMate 77T) were sponsored by Bristol-Myers Squibb, the manufacturer of nivolumab. The trials were conducted at Johns Hopkins and other clinical sites.

Bristol Immunotherapy Improves Responses In Lung Cancer, Setting Up Phase 3 Study

BARCELONA, Spain — Adding a second immunotherapy from Bristol Myers Squibb to an existing checkpoint inhibitor and chemotherapy improved responses for certain patients with a type of lung cancer, steering the approach into a Phase 3 study. 

The Phase 2 RELATIVITY-104 trial was another hurdle for Bristol's Opdualag, which is essentially a combination of the company's powerhouse PD-1 inhibitor Opdivo and relatlimab, which targets another checkpoint called LAG-3. Opdualag is approved in advanced melanoma, but the drug has failed in some colorectal and liver cancer indications. The dose tested in the lung cancer study was higher than the one approved in melanoma.

The new study tested relatlimab with Opdivo and chemotherapy versus Opdivo and chemotherapy alone as a first-line treatment in advanced non-small cell lung cancer, with the aim to find which patients benefited from adding the anti-LAG-3 drug to the backbone of chemotherapy and immunotherapy, Samit Hirawat, Bristol's chief medical officer, told STAT. 

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