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Dr. Afshin Safavi
Posted by Dr. Afshin Safavi Immunogenicity, Industry Update

The Evolving Treatment of Lung Cancer: From Combination Chemotherapy to Immune Checkpoint Inhibitors

The Evolving Treatment of Lung Cancer: From Combination Chemotherapy to Immune Checkpoint Inhibitors

Lung cancer quickly became the most common cancer worldwide in the last decade of the 20th century due to an increase in smoking rates. 1.8 million patients were diagnosed with the disease in 2012, and in the same year 1.6 million patients died from this cancer (1). However, in the last three decades milestones in treating both small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) have been met and then improved upon or superseded. The first significant milestone in treating this disease came from combination chemotherapy for patients with SCLC. Later, palliative chemotherapy was established for patients with advanced NSCLC and targeted therapies with angiogenesis inhibitors, EGFR inhibitors, and ALK inhibitors made an impact when used in treatments as determined by unique cancer cell characteristics. Most recently, the clinical introduction of immune checkpoint inhibitors has revolutionized the way we are treating all types of lung cancer.

Combination Chemotherapy
SCLC is a chemosensitive disease, and thus the discovery of the effectiveness of combination chemotherapy was an important milestone in treating the cancer. Combination chemotherapy, using different drugs to address different cancer qualities, repeatedly performed better than using a single drug type alone when looking at both survival and quality of life. The benefits of combination chemotherapy, including most importantly, tumor control, typically outweigh the associated chemotherapy toxicities.

Palliative Chemotherapy
The establishment of palliative chemotherapy is a major milestone in treating advanced NSCLC. By the third generation of cytotoxic drugs, side effects were greatly diminished. Superior drugs, like cisplatin-based chemotherapy, produce higher survival rates and improved patients’ quality of life as compared to traditional chemotherapies that produced devastating toxicities in the patient’s body.

Adjuvant Chemotherapy
In addition to treating lung cancers with variations and combinations of chemotherapy, approximately 25-30% of NSCLC patients have localized tumors and can be treated through surgery. Even though most of these surgeries are expected to be curative, 70% of patients will relapse as a result of micro-metastases that are already present at the time of surgery. Adjuvant chemotherapy refers to a chemotherapy treatment administered after the initial surgical intervention. As a result of this dual approach to treatment, patients generally experience increased longevity and disease-free survival rates.

Targeted Therapies
As the understanding of lung cancer grows, therapies have become progressively more targeted. Targeted therapies for advanced NSCLC represent another milestone in treating lung cancers. Studies have been conducted for drugs using angiogenesis, EGFR, and ALK inhibitors with some level of success in entering clinical practice. When a targeted therapy is used, qualities of the cancer itself inform the selection of the drug or the combination of drugs that will be used to most effectively treat the patient’s unique cancer.

Immune Checkpoint Inhibitors
Lung cancer was originally believed to be nonimmunogenic until the discovery of immune checkpoints within the patient’s immune system. The introduction of immune checkpoint inhibitors in clinical practice for patients with advanced NSCLC has been a major milestone in treating this type of cancer. As a result of this discovery, scientists have been able to further personalize lung cancer treatments by manipulating the body’s own immune system through the targeting of cytotoxic T lymphocyte-associated antigen 4 (CTLC4) and Programmed death-1 (PD-1). Two anti–PD-1 immune checkpoint inhibitors for second-line treatment of advanced NSCLC were recently approved by the FDA, leading to an increased use of these agents in clinical practice in the United States.

Even with the evolution of immune checkpoint inhibitors, there is still a lot of research and development to conduct on the topic of lung cancer treatment. The possibility of creating a more effective treatment regimen using immune checkpoint inhibitors alone, in combination or in conjunction with other treatments like targeted therapy, radiation, and chemotherapy, are being studied in ongoing clinical trials. In addition, as the understanding of the disease and its treatment alternatives grow, researchers will be able to identify relevant biomarkers to more easily diagnose and target the treatment.

If you’re interested in learning more about how BioAgilytix partners with innovators to support cancer treatment breakthroughs, speak to one of our scientists today or visit us at the 17th Annual ASCO Meeting from June 2-6, 2017 in Chicago, IL.

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