Two Years: Optimal Duration of Immunotherapy in Advanced Lung Cancer

Study suggests two-year immunotherapy treatment for advanced lung cancer may be reasonable

The introduction of immune checkpoint inhibitors has resulted in a paradigm shift in the management of advanced lung cancer, resulting in longer patient lives and improved overall survival.

However, one critical question remains unanswered: What is the appropriate duration of immunotherapy for patients with advanced non-small cell lung cancer (NSCLC) who receive it as their first treatment? ().

Test Your Knowledge on Immunotherapy Drugs
Immunotherapy is a type of treatment method that works by using certain components of a person's immune system to treat the disease.

There are two ways by which these therapies work:

Activation immunotherapies work by enhancing or stimulating the immune system. Examples in this category work to destroy cancer cells.
Suppression immunotherapies work by inhibiting or suppressing the immune system. Examples in this category are used to treat allergies and autoimmune diseases.

Test your knowledge and know more about immunotherapy drugs by taking this quiz.

‘Discontinuing immunotherapy at two years for advanced lung cancer patients may Be reasonable for long-term survival #LungCancer #immunotherapy’

According to a new retrospective cohort study published in JAMA Oncology and presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting (Abstract 9101) by researchers from Penn Medicine's Abramson Cancer Centre, discontinuing immunotherapy after two years is reasonable if cancer has not progressed.

The study found no statistically significant differences in overall survival between patients who discontinued medication ().

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“We hope this data provides reassurance that stopping treatment at two years is a valid treatment strategy that does not seem to compromise overall survival,” said lead author Lova Sun, MD, an assistant professor of Hematology-Oncology at the Perelman School of Medicine at the University of Pennsylvania.

“In the absence of definitive prospective data about the duration of therapy – which will take years to accumulate – our goal was to use real-world observational data to provide guidance on this important clinical question.”

Finding the Right Duration of Immunotherapy forAdvanced Lung Cancer

The appropriate length of treatment remains an open question because pivotal clinical trials have used different treatment durations, and as therapies have been approved and become widely available, many patients have continued therapy beyond the one to two years tested in clinical trials.

Cancer Immunotherapy
Cancer immunotherapy is a new advancement in cancer treatment that uses certain components of a person's immune system to fight against cancer cells.

The longer a patient continues treatment, the higher the health care costs become – both to the patient and to the health care system – and there is an ongoing risk of immune-related side effects.

In this study, the researchers analyzed de-identified data from a national electronic health record that included patients with advanced NSCLC who were treated in both academic and community settings.

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Of the 1,091 patients who received an immune checkpoint inhibitor as part of their initial therapy (either alone or in combination with chemotherapy) and whose cancer had not continued to grow, only one in five stopped immunotherapy at two years and were considered the “fixed duration” group for this analysis. The vast majority who continued treatment beyond two years were considered the “indefinite duration” group.

The team analyzed the data and found similar overall survival probabilities between the two groups: 79% for a fixed duration and 81% for an indefinite duration.

“Ultimately, the field is still on the leading edge of determining the most appropriate duration for these immunotherapies that have been so effective for patients with advanced lung cancer,” said senior author Charu Aggarwal, MD, MPH, the Leslye M. Heisler Associate Professor for Lung Cancer Excellence in Hematology-Oncology at Penn.

“This study provides important data that we hope will help patients feel less worried about potential risks of coming off therapy and more confident if they decide to discontinue treatment after two years.”

Referenes:

Immunotherapy in Lung Cancer: Current Landscape and Future Directions - (https://pubmed.ncbi.nlm.nih.gov/35222404/)
Association Between Duration of Immunotherapy and Overall Survival in Advanced Non-Small Cell Lung Cancer - (https://pubmed.ncbi.nlm.nih.gov/37270700/)

Source-Eurekalert