By Stephanie Watson
WebMD Health News
Lung cancer is the number one cause of cancer deaths among both men and women. But there is reason for hope. Roy S. Herbst, MD, PhD, chief of medical oncology at Yale Cancer Center, recently wrote an editorial about a The New England Journal of Medicine study of the immunotherapy drug, nivolumab (Opdivo) to shrink early-stage lung tumors before surgery. He tells WebMD what makes Opdivo and other immunotherapy drugs so promising, and how these and other new therapies are transforming the outlook for people with lung cancer.
WebMD: Why has lung cancer been so difficult to treat up to now?
Herbst: More than half the time, lung cancer has already spread from the lungs when it’s diagnosed. That makes it difficult to remove with surgery or radiation. And chemotherapy really isn’t that effective for lung cancer. Lung cancer is often resistant to chemotherapy. Immunotherapy offers the benefit of long-term survival and response.
WebMD: How does immunotherapy work?
Herbst: Usually the tumor is invisible to the immune system. What immunotherapy can do is unlock the power of the body’s immune system to allow it to find and target the cancer. What we’re seeing now is that it works, and it works in so many different cancer types. That’s just extraordinary.
WebMD: What made the recent study of nivolumab so exciting?
Herbst: Lung tumors make a protein called PDL-1, which prevent immune cells from killing the tumor. It’s like a cloaking device that keeps the tumor from being recognized. Nivolumab blocks the activity of PDL-1, which reactivates immune cells against the tumor. We’ve known that nivolumab works against cancer cells, but to see an effect in early-stage lung cancer like in this trial suggests that the effect might be even greater in early-stage disease. So I think that’s very exciting. It also means we can use nivolumab to develop even better drug combinations in the future.
WebMD: Are there any caveats to the study?
Herbst: It was small. It only had 20 patients. So it’s not going to change practice right now. But I think it’s going to lead to even more trials looking at drugs like this early on, before the tumor is removed with surgery.
WebMD: What are some of the other advances you’re seeing in lung cancer treatment?
Herbst: Targeted therapies — drugs that target mutations like EGFR in cancer cells — are showing great promise. About 10% of people with non-small cell lung cancer have these mutations. The mutations make tumors resistant to treatment. Now we can develop drugs to target that resistance. Osimertinib (Tagrisso) is a therapy that works in people with EGFR mutations who develop resistance.
Right now in lung cancer therapy, we have targeted therapies, immunotherapy, radiation therapy, and chemotherapy. The trick is going to be using them together to have the largest impact on the disease.
WebMD: What types of progress are we seeing today in terms of lung cancer patients’ longevity?
Herbst: The fact that now we have patients with lung cancer who get immunotherapy as the first therapy for their disease is extraordinary. Immunotherapy has a chance of improving their long-term survival. When we use immunotherapy and chemotherapy together, or immunotherapy alone, we have a 1-year survival rate of 70%. It used to be we’d see a 10% or 20% survival rate just 10 years ago. So there’s been an amazing advance in the treatment of lung cancer over the last decade.
WebMD: What are the current limitations of immunotherapy?
Herbst: About 50% of our patients’ disease progresses at one year. So we’re helping about half of patients now, up from about 10 or 20% a decade ago. We still have a long way to go. To help the rest of patients, we need to bring therapies from the lab into the clinic. And to do that, we have to do clinical trials. We have to give patients the drugs before they have surgery and see what happens to the tumor, and learn why they respond or don’t respond. To have clinical trials we need funding, patient enrollment, and collaboration between research groups.
WebMD: How can lung cancer patients learn about new treatments that may not be available yet from their doctors?
Herbst: They should ask their doctors about clinical trials. Patients who have already had the standard therapies and need something new should look for early drug development programs. Those are usually done at major cancer centers.