Combining chemotherapy and immunotherapy before surgery improves lung cancer patients

The combination of immunotherapy plus chemotherapy prior to surgery improves event-free survival in patients with lung cancer resectable non-small cell tumor, according to a study involving the Vall d’Hebron Institute of Oncology (VHIO).

The study, published in the journal ‘The New England Journal of Medicine’, has shown that neoadjuvant treatment with nivolumab plus chemotherapy given before surgery in patients with non-small cell lung cancer (NSCLC) resectable also improves long-term complete pathologic response, especially in patients with poor prognosis.

With the results of this study, nivolumab in combination with chemotherapy has been approved in the United States by the US Food and Drug Administration (FDA) as a neoadjuvant treatment for this type of lung cancer and it is expected that in Europe it will mean a change in the treatment standard for these patients.

This is the phase III study CheckMate 816, in which 352 patients with resectable non-small cell lung cancer (NSCLC) who had received either neoadjuvant treatment with immunotherapy (nivolumab) plus chemotherapy or chemotherapy alone, before surgery.

The median event-free survival was 31.6 months in the first group compared to 20.8 months in the second group, who had only received chemotherapy.

Pathological complete response rate was 24% in treatment with immunotherapy plus chemotherapy, compared to 2.2% of the second group, with chemotherapy alone.

At one year, 76.1% of patients treated with nivolumab and chemotherapy they survived without progressing to the disease compared to 63.4% of those treated with chemotherapy alone.

At two years old, the data was from 63.8% of the patients in the first group compared to 45.3% of the second group.

These data show, according to oncologists, that the administration of neoadjuvant treatment of three cycles of nivolumab ‒an anti-PD-1 antibody that restores the function of existing antitumor T cells‒ plus chemotherapy may improve long-term clinical outcomes in patients with NSCLC resectable stage IB-IIIA without impeding the feasibility of surgery or increasing the incidence of adverse events compared to chemotherapy.

“The use of immunotherapy together with chemotherapy as neoadjuvant treatment it may offer a promising treatment option in patients with resectable NSCLC prior to surgery; which would allow us to treat the disease early and improve the event-free survival of these patients, reducing the risk of relapse”, summarized the head of the section ofl Vall d’Hebron Hospital Medical Oncology Service, Henrietta Philip.

According to Felip, who is also president of the Spanish Society of Medical Oncology (SEOM), “Until now, immunotherapy had managed to demonstrate its benefits in advanced stages of the disease and in postoperative treatment, but these results could lead to a change in clinical practice and the incorporation of chemotherapy in combination with immunotherapy in preoperative treatment.”