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Ivan Pourmir (medical oncologist)
A global study has shown that atezolizumab, a cancer immunotherapy, significantly improves the overall survival of patients with a form that is difficult to treat with chemotherapy. New hope for those affected?
The leading cause of death worldwide, lung cancer accounts for 2.2 million new cases per year and 1.8 million deaths. The majority of these patients have what is called advanced non-small cell lung cancer (NSCLC) for which first-line immunotherapy with or without platinum-based chemotherapy (PDC) is now established as treatment. reference. However, more than 40% of patients with advanced NSCLC are in poor health and cannot tolerate this standard PDC treatment, leaving them with limited treatment options. But a trial focused on a first-line immunotherapeutic treatment with atezolizumab would yield promising results. The results are published today in The Lancet.
Twice as many patients alive two years later
The trial aimed to establish the efficacy, safety and overall survival rate of first-line immunotherapy treatment with atezolizumab compared to chemotherapy monotherapy in patients with non-small cell lung cancer at an advanced stage. 302 patients received atezolizumab and 151 received chemotherapy monotherapy.
The study showed that atezolizumab significantly improved overall survival and resulted in a clinically meaningful long-term survival benefit, with twice as many patients (24%) treated with atezolizumab remaining alive at two years than those treated with chemotherapy (12%). although more than 50% of chemotherapy patients who were alive at two years received subsequent immunotherapy.
For Prr Siow Ming Lee (UCL Cancer Institute and UCL Hospitals), who chaired the study steering committee and conceptualized the study design, the treatment also resulted in “stabilization or improvement in health-related quality of life measures, and no new safety issues were identified.”
A trial conducted on normally excluded groups
To better understand the value of this trial, we contacted Dr. Ivan Pourmir, medical oncologist and member of our committee of experts. He explains that this trial leads to useful and concrete information to guide the treatment of patients with advanced lung cancer.
“The general condition of cancer patients is usually assessed using a score defined by the WHO called Performance Status (PS) which ranges from 0 (normal condition) to 4 (bedridden condition). Usually it is considered that patients with a PS of 3 or more can receive no treatment, while in those over 70 years of age treatment is often limited by the existence of other chronic diseases (e.g. renal failure, heart failure …). Patients in this situation are most often excluded from clinical trials of lung cancer immunotherapy. But this trial therefore recruited patients with a PS of 2 or 3 and/or an age greater than 70 combined with chronic illnesses making them unfit to receive the most intensive chemotherapy (which combines a powerful chemotherapy, carboplatin, with another drug). He compared in these patients the use of an immunotherapy already commonly used in patients in better general condition, Atezolizumab, with low-intensity chemotherapy.
In his own opinion, the results here are encouraging and show a benefit of immunotherapy in some of these patients, with a significant, although modest, proportion remaining alive beyond 2 years of follow-up. However, there are limitations to these results:
“We see that in the initial phase of treatment more people on immunotherapy died quickly compared to chemotherapy, so we should see what are the characteristics of these patients for whom immunotherapy seems to be the bad option. On the other hand, the practice in France is to administer a more powerful chemotherapy which includes Carboplatin in patients who have a PS of 2 without other comorbidities, and not to reserve a “small” chemotherapy for them as was the case. here. Thus, these results do not provide certainty for these patients that immunotherapy would provide them with a better result. Finally, the results on the quality of life questionnaires are difficult to interpret because the patients and the investigators knew the treatments received, which can strongly bias their assessment of the symptoms, in particular due to the placebo effect.”
A validated hope therefore, but which still needs to be refined.