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Immunotherapy plus chemo doubles lung cancer survival, study says

Chemotherapy and radiation are common treatments for lung cancer. However, immunotherapy may be able to help double a patient’s survival, according to a new report.

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Researchers from New York University’s Perlmutter Cancer Center recently conducted a study, published in the New England Journal of Medicine, to determine which treatments were most effective for those newly diagnosed with lung cancer.

To do so, they examined 616 people with non-squamous non-small cell lung cancer from 118 international sites. The participants did not have genetic changes in the EGFR or ALK genes, which have both been linked to the rapid reproduction of cells. 

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About 400 of the subjects underwent pembrolizumab, a form of immunotherapy that helps destroy cancer cells; platinum therapy, a procedure that uses cell damaging agents; and pemetrexed, a chemotherapy drug that targets the lungs. The other 200 only received platinum therapy and pemetrexed with a saline placebo. 

After analyzing the results, they found the risk of death was reduced by 51 percent for those treated with pembrolizumab, platinum therapy and pemetrexed, compared with those who only got chemo. Furthermore, those with the combined therapy also had a 48 percent decreased chance of progression or death. 

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Suresh Ramalingam, deputy director at Emory University’s Winship Cancer Institute, told The Atlanta Journal-Constitution the finding is “very important” as “it moves the milestone forward.”

“This study shows that by combining the two treatments, you can maximize or even improve patient outcomes. From that standpoint, it does shift the treatment approach to lung cancer in a positive way,” said Ramalingam, who was not a part of the trial.

By using both approaches together, doctors can create a multiplying effect. During chemotherapy, cells die and leave behind protein. Immunotherapy activates the immune system, aiding its ability to kill any remaining cancer cells.

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The NYU researchers did note there are severe side effects to the combination treatment, including nausea, anemia, fatigue and an increased risk of acute kidney injury. 

However, Ramalingam believes the trial gives experts the ammunition to test the approach in many other cancers. He also said there are several ways to treat different types of the disease, and people should understand that some tumors may need to be tackled differently.

For example, he recently led a separate, large clinical trial that targeted lung cancer patients with the EGFR mutation, unlike the NYU analysts. As a result of his findings, the U.S. Food and Drug Administration expanded the use of a lung cancer pill called Tagrisso to those with the EGFR gene.

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While it was initially only used for individuals whose lung cancer worsened after treatment with other EGFR therapies, Ramalingam and his team proved the medication almost doubled the survival outcome for newly diagnosed lung cancer patients with the EGFR mutation. In fact, it resulted in better outcomes than chemotherapy and immunotherapy. 

“Given all these exciting advances that there are in lung cancer, patients should not settle for what’s been told,” Ramlingam recommended. “Basically get a second option or go to a major center that specializes in lung cancer to make sure they’re getting the cutting-edge treatment options that are out there.”

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