For lung cancer patients like Evelyn O’Flynn, a new drug is being hailed as life-changing. "It’s like a miracle," said the 72-year-old ex-smoker, who is about to become a great-grandmother. While she still has cancer, after going straight on to the immune system-boosting drug more than a year ago, rather than traditional hard-to-tolerate chemotherapy, she is feeling great.

In a breakthrough third phase clinical trial involving non-small-cell lung cancer (NSCLC) patients, pharmaceutical company Merck has announced that their new treatment – a synthesised antibody that triggers the immune system to attack the tumour cells, has been 40% more effective as compared to conventional chemotherapy.

First-time patients administered with the new drug, known as pembrolizumab, saw better response rate in their treatment, reporting longer life spans, with lower rates of disease progression after being on the treatment as compared to traditional chemotherapy.

In fact, the new treatment reported such high levels of efficacy and the difference was so stark, as compared to chemotherapy, that those on chemotherapy were allowed to transition into the new treatment.

Results not without controversy

However, in the second and most recent follow up study, 108 deaths had occurred out of 1,934 participants. Slightly more than 80% of those on the new treatment were alive after six months, as compared to slightly more than 72% for those patients who was exclusively on chemotherapy.

Yet, in all almost cases, the new treatment was proven to be better than chemotherapy.

At the press conference, Dr. Stefan Zimmermann, an oncologist at the University Hospital in Switzerland, exclaimed to reporters, "Remember this day. It's a new day for lung cancer treatment.”

In Singapore, lung cancer is the second and third most common cancer amongst men and woman respectively, with a total of 6,853 individuals diagnosed and claimed 5,721 lives, from years 2010 to 2014. In Malaysia, lung cancer is the most commonly diagnosed cancer amongst men, and is the third more common cancer amongst woman.

More refined treatment regime

Pembrolizumab had already gained prior approval as a second-line treatment for certain late stage head-and-neck cancers by the U.S. Food and Drug Administration (FDA), but its efficacy as a first-line treatment remains unproven.

Learning from the failed trail of a similar drug by competitor Bristol-Myers Squibb, Merck refined its goal. The target audience was changed and focused towards patients with a specific type of NSCLC – patients’ whose cancer cells contains PD-L1, a protein that normally blocks white blood cells from unnecessarily killing off healthy cells but which can also help cancer cells avoid destruction.

The researchers estimate that 23 to 28% of advanced NSCLC cases conform to this criteria, with NSCLC being the most common type of lung cancer.

About 2,000 Individuals on the drug have managed to reduce the risk of death by as much as 40% when compared to traditional treatments. More optimistically, in a smaller trial presented at the same conference, researchers said they found that combined treatment with chemotherapy proved to be even more effective than with either therapy alone.

Awaiting first-line treatment approval

In an accompanying editorial published in New England Journal of Medicine, these results brought hope that in the near future, patients could be granted with differing combinations of immunotherapy and chemotherapy, which would be dependent on depending their PDL1 makeup of their cancer.

The FDA is expected to announce the new drug’s approval status for first-line treatment before the end of the year. MIMS

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Sources:
http://www.reuters.com/article/us-health-cancer-immunotherapy-insight-idUSKCN12A1OH
http://www.medicaldaily.com/new-day-lung-cancer-treatment-experimental-therapy-40-better-chemotherapy-400570
http://www.nejm.org/doi/full/10.1056/NEJMoa1606774#t=articleDiscussion
http://www.themalaymailonline.com/malaysia/article/lung-cancer-malaysian-mens-number-one-enemy-says-deputy-health-minister
https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/cancer-trends-2010-2014_interim-annual-report_final-(public).pdf?sfvrsn=0&AspxAutoDetectCookieSupport=1