Immunotherapy Drug Helping Lung Cancer Patients
By Robert Preidt
The immunotherapy drug Tecentriq (atezolizumab) was approved earlier this year by the U.S. Food and Drug Administration to treat patients with newly diagnosed non-small cell lung cancers (NSCLC), which comprise up to 85% of all lung tumors.
Tecentriq targets a protein known as PD-L1 that lies on the surface of tumor cells. Normally, this protein signals the body’s immune system T cells not to attack. However, by targeting PD-L1, Tecentriq unleashes the body’s natural T cells to target and destroy these cancer cells, researchers at Yale Cancer Center explained.
Tecentriq “has already shown excellent activity in patients who progress on frontline chemotherapy, but this study confirmed that the drug is active in selected patients who have not yet received any treatment for lung cancer,” said medical oncologist Dr. Nagashree Seetharamu, who treats lung cancer patients but wasn’t involved in the new study. She practices at Northwell Health Cancer Institute in Lake Success, N.Y.
The new study was funded by Tecentriq’s maker, Genentech, and the results were published Sept. 30 in the New England Journal of Medicine.
The study included 554 patients with stage 4 metastatic NSCLC tumors. All patients had tumors lacking mutations in the EGFR or ALK genes: As the researchers explained in a Yale news release, tumors with those mutations are better treated with other drugs.
Among 205 patients whose tumors had high cellular expression of PD-L1, the median overall survival was 20 months for those who received Tecentriq versus 13 months for those who received standard platinum-based chemotherapy.
Median progression-free survival — the time from treatment to the disease beginning to worsen — was eight months for patients who received Tecentriq versus five months for those on standard chemotherapy, the researchers found.
“These are exciting results that could be life-changing for many patients,” said study lead author Dr. Roy Herbst. He is chief of medical oncology at the Yale Cancer Center as well as the Smilow Cancer Hospital.
“Lung cancer is the most common cancer worldwide, with more than 1.5 million patients diagnosed each year. Half of patients are diagnosed with metastatic disease, and they could be a candidate for this drug,” Herbst said in the news release.
“Also encouraging is that [Tecentriq] was generally well tolerated,” said Herbst, who is also associate cancer center director for translational research at the Yale Cancer Center in New Haven, Conn. “Side effects for patients were similar to those seen in other trials of the drug, which has been approved for treatments of several types of cancer.”
The trial also assessed how Tecentriq performed among patients with a “high tumor mutational burden,” which means that they had high levels of genetic mutations in scraps of cancer DNA detected in blood tests. In some types of cancers, high mutational burden is tied to better responses to immunotherapy drugs like Tecentriq.
“Among these patients with NSCLC, those with high tumor mutational burden who received [Tecentriq] showed improved progression-free survival of seven months versus four months for those given chemotherapy,” Herbst said. “This finding suggests that the [blood] biomarker should be explored further.”
For her part, Seetharamu noted that “there are many commercially available and experimental drugs that target PD-L1.” And she noted that the study did have one flaw.
Tecentriq “was compared to platinum-based chemotherapy alone, which is now not the most common standard treatment,” Seetharamu pointed out. Instead, oncologists are increasingly using standard chemotherapy plus another type of immunotherapy drug, Keytruda. The new study didn’t present a head-to-head comparison of Tecentriq against chemotherapy-plus-Keytruda, however.
“That is understandable,” Seetharamu said, “since the study started before these new treatments made it into common clinical practice.”
Regardless, she said, “the overall survival of 20 months in selected patients with high PD-L1 expression treated with Tecentriq alone is impressive and may provide yet another non-chemotherapy treatment option for patients diagnosed with PD-L1-high lung cancer.”