Three new advances are poised to transform the treatment of lung cancer – reversing the tide of a disease that is often seen as a death sentence. A person in the UK is diagnosed with lung cancer every ten minutes – representing around 50,000 new patients each year – and only a quarter survive five years. Some 35,000 people die from it each year, making it our biggest cancer killer.
But this weekend, the doctors treating him had reason to rejoice, as a range of highly effective new therapies were unveiled at the American Society for Clinical Oncology (ASCO) conference in Chicago.
Over the past few decades, research has made enormous strides in tackling other common forms of the disease, such as breast, prostate and bowel cancer – and, more recently, new Targeted treatments for “once hopeless” melanoma skin cancer have seen patients effectively cured.
Experts say they are awfully close to a similar breakthrough with lung cancer.
“When I became a doctor, nobody wanted to specialize in lung cancer because for most patients it was a death sentence and we had no treatment to stop it,” says James Spicer, professor of Experimental Cancer Medicine at King’s College London.
Three new advances are poised to transform the treatment of lung cancer – reversing the course of a disease that is often seen as a death sentence
“Today, new drugs mean that even patients whose cancer has spread throughout the body live another ten or even 15 years.
“We’re at a point where we’re starting to talk about cures for these advanced patients.”
Perhaps the greatest excitement was for people with early-stage lung cancer, who could soon receive a high-tech drug that boosts the immune system, after a groundbreaking study found the treatment slows considerably the return of the disease.
The injection, called pembrolizumab, helps the immune system find hidden cancer cells in the body. It is currently only offered to NHS patients with advanced lung cancer whose disease has spread. But the treatment could now be offered to thousands more.
Researchers at Stanford University in California found that when taken alongside chemotherapy in the three months before surgery and then for a year after, pembrolizumab significantly reduced the risk of a recurrence. early-stage lung cancer, compared to chemotherapy before surgery. .
Perhaps the greatest excitement was for people with early-stage lung cancer, who could soon receive a high-tech drug that boosts the immune system, after a groundbreaking study found the treatment slows considerably the return of the disease.
On average, patients on the new treatment were still cancer-free after nearly a year, while those who received only chemotherapy were disease-free for only four months.
Although smoking-related lung cancer is on the decline as more people quit smoking, non-smoking lung cancer is on the rise, for reasons that are not fully understood.
The trial included patients with non-small cell lung cancer, the most common form of the disease, which accounts for around 80% of new cases of lung cancer.
While trial researchers said it was too early to say exactly how many more months patients on pembrolizumab are expected to live, experts say the early signs are overwhelmingly positive.
“The data we’ve seen shows that if you take this treatment, you’re half the chance of your cancer coming back,” Prof Spicer says.
“This is extremely positive for these patients, who can expect to live much longer as a result.” The study also shows that, in some cases, researchers were unable to find any signs of cancer. These patients are indeed cured.
Pembrolizumab is called a checkpoint inhibitor, which helps the immune system find tumor cells and destroy them.
Given by injection every three weeks, it has already proven to be a remarkably effective treatment in patients with melanoma, skin cancer, bladder cancer and lymphoma. Experts say the new diet is likely to become routine treatment for lung cancer patients on the NHS. “The data show that giving pembrolizumab at the same time as chemotherapy can reduce the risk of relapse in all patients with this form of lung cancer,” says Professor Spicer. “This will soon be the NHS standard of care.”
The injection, called pembrolizumab, helps the immune system find hidden cancer cells in the body. It is currently only offered to NHS patients with advanced lung cancer whose disease has spread. But the treatment could now be offered to thousands more
Experts say the next step will be to see if the number of pembrolizumab injections can be reduced.
“This drug seems to save people time, but patients still have to go to the hospital regularly for their treatment,” says Professor Jyoti Patel, an expert in clinical cancer research at Northwestern University, Illinois. . “These immunotherapy drugs are also not without side effects and they can increase the risk of other diseases as they impact the immune system.
“Future trials need to examine whether we can defuse the treatment, so that patients receive fewer doses and thus have fewer side effects.”
Another challenge is to identify lung cancer early enough to be able to offer patients this new treatment. Studies show that currently only about a fifth of lung cancer cases are detected at an early stage.
Speaking at the ASCO conference, the trial’s principal investigator, Dr Heather Wakelee, head of Stanford University’s division of oncology, called for more research into cancer screening of the lung. “Without screening, we cannot find patients with early-stage disease,” she said. “It is important that we continue to put a lot of effort into improving screening.”
But experts say an NHS lung cancer screening program is already within reach.
In Manchester, a Lung Health Check is offered to everyone aged 55 to 74 who smokes or has smoked. “It could extend to the whole of the NHS,” says Professor Spicer.
If approved by the NHS, pembrolizumab can be combined with another medicine.
A trial due to be presented at the ASCO conference tomorrow is expected to show that the immune-boosting drug osimertinib, created by British company Astrazeneca, significantly improves survival time for people with lung cancer non-small cell with a specific genetic mutation called EGFR.
Although this mutation is only carried by 15% of lung cancer patients, experts believe that this figure will increase in the coming years, as it is linked to the increase in lung cancer cases linked to non-smoker.
Studies suggest that these cases could be linked to pollution. Osimertinib is only available on the NHS for patients with the EGFR mutation whose disease has spread to other organs.
Experts are also excited about another lung cancer drug being showcased at ASCO. Known as SKB264, it has been dubbed “a warhead” because it can penetrate tumors, delivering a powerful “payload” of chemotherapy drugs that attack cancer cells from within.
The highly precise treatment, known medically as an antibody-drug conjugate, avoids harming healthy tissue, meaning doctors can administer higher doses without worsening side effects.
In a trial of 43 patients with advanced lung cancer that had come back after surgery and conducted by Chinese drug developer Kelun, SKB264 was shown to reduce the size of lung cancer tumors in approximately 45% of attendees.
Dr Heather Wakelee, head of Stanford University’s division of oncology, has called for more research into lung cancer screening. “Without screening, we cannot find patients with early-stage disease,” she said. “It is important that we continue to put a lot of effort into improving screening”
For this group, chemotherapy only works in about 20% of patients and remains effective for less than four months.
Patients who responded to SKB264 had their tumors under control for more than nine months. Experts say this means SKB264 could potentially double the survival time of this group of patients.
Experts say warhead drugs like SKB264 could soon be combined with immunotherapy and chemotherapy to further prolong the lives of lung cancer patients.
‘Antibody-drug conjugates deliver toxic drugs directly to tumours,’ explains Professor Spicer. “Only 20% of lung cancer patients are actually cured. Antibody-drug conjugates could increase this number.
