Advances in lung cancer treatment: perioperative immunotherapy
Lung cancer is the leading cause mortality are associated with cancer worldwide, with non-small cell lung cancer (NSCLC) accounting for approximately 85% of all cases.
A recent study shows that perioperative immunotherapy in combination with chemotherapy improves overall survival patients with resectable stage IIIA non-small cell lung cancer without toxicities of concern.
The NADIM study, published in The Lancet, also included researchers from Spanish Society of Thoracic Surgery (SECTOR). Additionally, the study shows that 69% of patients are still alive at 5 years, so the results support the idea of using this combination treatment in patients who are candidates for surgery with this subtype of lung tumor.
Almost 30% of patients undergo surgery, but despite this, studies conducted so far provide only data on patient survival. five years little hope.
The first study to evaluate perioperative chemoimmunotherapy.
Recently, it has been noted that immunotherapy is directed against specific goalsbased on blockade of PD-1 or PD-L1 proteins, has revolutionized the treatment of this cancer subtype, resectable NSCLC, performed either before surgery (in a neoadjuvant approach) or after surgery (in an adjuvant approach).
To evaluate the results of such treatment in terms of survival, the NADIM study was conducted. “Combination advantages The use of neoadjuvant and adjuvant immunotherapy in perioperative regimens has the potential to improve long-term outcomes in non-small cell lung cancer.
To the best of our knowledge, the NADIM study was the first evaluate activities perioperative chemoimmunotherapy for potentially resectable stage IIIA NSCLC, and now, in a phase II study, we have confirmed that it also improves long-term survival rates,” said the thoracic surgeon, SECT Scientific Committee Coordinator and co-author. Research, David Gomez de Antonio.
Research and its results
The NADIM study is a multicenter, single-arm, phase 2 study conducted in 18 hospitals in Spain. It assessed the eligibility of 51 patients with resectable stage IIIA NSCLC over the age of 18 years, of whom 46 were ultimately intention-to-treat patients, meaning those who could be offered treatment.
Of these patients, 36 (74% of the sample) were men and 12 (26%), womenaverage age 63 years. Patient follow-up ended after five years (60 months), and the start date for analysis was July 11, 2023.
Before operationPatients received neoadjuvant treatment consisting of three cycles of chemotherapy in combination with immunotherapy nivolumab (360 mg). Patients then underwent surgery to remove the lung tumor and postoperatively received adjuvant treatment with intravenous nivolumab monotherapy for one year.
Progression-free survival at 24 months
He criterion from basic assessment Progression-free survival at 24 months was studied. Secondary study objectives included five-year progression-free survival, overall survival, and toxicity profile.
Survival is free population growth the five-year study rate was 65 percent, and overall survival was 69.3 percent. These survival rates were accompanied by high rates of pathological complete responses. However, disease progression occurred in 11 patients, 24 percent of the sample, and 14 patients (30%) died, including nine (20%) from recurrent disease and five (11%) from causes unrelated to the tumor.
Regarding toxicity, treatment-related adverse events occurred in 14 patients (30%) of 46 during the treatment period. neoadjuvant treatmentand in seven (19%) of 37 during adjuvant treatment. side effects The most common, rated 3 or higher, were increased lipase, an enzyme produced by the pancreas to break down fats in food, and febrile neutropenia, a decreased number of neutrophils, a type of white blood cell or guard cell. Each of these side effects occurred in three patients (7% of the sample).