Combination therapy improves small-cell lung cancer survival

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Patients with stage IV small-cell lung cancer lived longer when given the immunotherapy atezolizumab with chemotherapy, setting the stage for what could become the first new treatment approved in decades for this particularly aggressive form of lung cancer.

Results of the study published recently in the New England Journal of Medicine showed that patients who got atezolizumab in addition to standard chemotherapy lived two months longer than those treated with chemotherapy alone.

“This is the first positive study for immunotherapy with chemotherapy in small-cell lung cancer,” said Leora Horn, MD, MSc, Ingram Associate Professor of Cancer Research and clinical director of Thoracic Oncology at Vanderbilt-Ingram Cancer Center (VICC).

“It is actually the first positive study in small-cell lung cancer — for a first line treatment — in three decades. There hasn’t really been a significant change in practice patterns with platinum and etoposide being standard of care. This trial is exciting because it the first time where we have achieved better patient outcomes with something other than chemotherapy.”

Results of the study were announced during the World Conference on Lung Cancer in Toronto. In the randomized trial, 201 patients were given atezolizumab with standard chemotherapy treatment while 202 patients received placebo with chemotherapy.

The median overall survival was 12.3 months in the atezolizumab group and 10.3 months in the placebo group.

“The median survival for a patient with incurable small-cell lung cancer is less than one year,” Horn said. “A lot of studies will quote a survival of around nine months in patients with advanced stage disease. This is the first phase III study where survival is just more than one year for patients treated with combination therapy and immunotherapy in advanced stage disease.”

The global trial was supported by F. Hoffman-La Roche/Genentech, a member of the Roche Group. The pharmaceutical company is the maker of atezolizumab, which received approval as a treatment for another type of lung cancer, non-small cell lung cancer, from the U.S. Food and Drug Administration (FDA) in October 2016.

“What’s interesting about immunotherapy drugs is it is the first time that we have seen a single class of drugs transcend so many different tumor types,” Horn said. “They are already FDA approved in melanoma, in non-small cell lung cancer, in lymphoma, in kidney cancer, in head and neck cancer and in bladder cancer. Now, we can hopefully add small-cell lung cancer to that list. It is not yet FDA approved, but I would anticipate regulatory approval because this is a positive study and it is practice changing for these patients.”

Given the success in advanced-stage disease, there are similar ongoing trials with other checkpoint inhibitors for patients with stage II and stage III small-cell lung cancer.

“There is a study with a different company that we are going to be participating in that is going to take people who have earlier stage disease that can be curable with chemotherapy and radiation, because small-cell lung cancer tends not to be an operative disease,” Horn said.

“Even with those patients who get chemotherapy and radiation upfront, only 25 percent are cured. Seventy-five percent will eventually end up with stage IV disease. We will try to see if chemotherapy and radiation followed by immunotherapy can improve survival for those patients.”

Vanderbilt University


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