When do I need immunotherapy once my regional (stage III) lung cancer has been treated with chemotherapy and chest irradiation?
When do I need immunotherapy once my regional (stage III) lung cancer has been treated with chemotherapy and chest irradiation?
Your medical team has recommended the combination of chemotherapy and chest radiation as the treatment for your lung cancer, that has spread to lymph nodes in the chest (stage III disease). However, this treatment leads to long-term cures in only a minority. A large clinical trial evaluated the addition of immunotherapy for 12 months following completion of thoracic chemoradiation, and recent long-term follow-up revealed a large improvement in patient survival at 5-years follow-up with immunotherapy [1]. A second trial recently confirmed the benefits of administering immunotherapy in this manner using a different immunotherapy agent [2].
The addition of immunotherapy was particularly effective in reducing the likelihood of any tumor recurrences outside the chest, and it also reduced the risk of tumor relapse in the chest. This benefit was achieved without impairing patient-reported quality of life outcomes when immunotherapy was administered [3].
Before determining whether immunotherapy is a suitable treatment for you, the medical team will assess your tumor characteristics (pathology) as well and your general fitness after completing thoracic chemoradiation. In suitable patients, immunotherapy is administered monthly as an infusion at the outpatients clinic, and patients are regularly assessed with blood tests and periodic CT scans in order to exclude any side effects of immunotherapy or for recurrent lung cancer. Some patients may require treatment for side-effects such as thyroid gland dysfunction and lung inflammation.
The author of the article Professor Suresh Senan has received institutional research support from Varian Medical System, ViewRay Inc., AstraZeneca and BMS. Professor Senan is also part of the Advisory board for Varian Medical System, ViewRay Inc., AstraZeneca, Roche, MSD, Janssen and BeiGene.
References
[1] Spigel DR, Faivre-Finn C, Gray JE, Vicente D, Planchard D, Paz-Ares L, Vansteenkiste JF, Garassino MC, Hui R, Quantin X, Rimner A, Wu YL, Özgüroğlu M, Lee KH, Kato T, de Wit M, Kurata T, Reck M, Cho BC, Senan S, Naidoo J, Mann H, Newton M, Thiyagarajah P, Antonia SJ. Five-Year Survival Outcomes From the PACIFIC Trial: Durvalumab After Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. Journal of Clinical Oncology. 2022 Apr 20;40(12):1301-1311
[2] Zhou Q, Chen M, Jiang O, Pan Y, Hu D, Lin Q, Wu G, Cui J, Chang J, Cheng Y, Huang C, Liu A, Yang N, Gong Y, Zhu C, Ma Z, Fang J, Chen G, Zhao J, Shi A, Lin Y, Li G, Liu Y, Wang D, Wu R, Xu X, Shi J, Liu Z, Cui N, Wang J, Wang Q, Zhang R, Yang J, Wu YL. Sugemalimab versus placebo after concurrent or sequential chemoradiotherapy in patients with locally advanced, unresectable, stage III non-small-cell lung cancer in China (GEMSTONE-301): interim results of a randomised, double-blind, multicentre, phase 3 trial. Lancet Oncology. 2022 Feb;23(2):209-219.
[3] Hui R, Özgüroğlu M, Villegas A, Daniel D, Vicente D, Murakami S, Yokoi T, Chiappori A, Lee KH, de Wit M, Cho BC, Gray JE, Rydén A, Viviers L, Poole L, Zhang Y, Dennis PA, Antonia SJ. Patient-reported outcomes with durvalumab after chemoradiotherapy in stage III, unresectable non-small-cell lung cancer (PACIFIC): a randomised, controlled, phase 3 study. Lancet Oncology. 2019 Dec;20(12):1670-1680.