A tumor that is difficult to treat and that in 2020, in Italy alone, registered 41,000 new cases. Lung cancer is one of the most frightening neoplasms but a new approach that has given very encouraging results comes from new studies presented to the Congress of the American Society of Clinical Oncology (ASCO): The combination of immunotherapy and chemotherapy given before surgery (neoadjuvant) works in early stage lung cancer and can increase the number of recoveries. This is demonstrated by the updated data from the phase 3 CheckMate-816 study, in which the combination of nivolumab, an immunocologic molecule, and chemotherapy was administered to people with operable non-small cell lung cancer. In patients who, after treatment with chemioimmunoterapia, obtain the complete pathological response, that is, they no longer show signs of disease, the reduction in the risk of recurrence exceeds 80%. Not only. The 3-year results of dual immunotherapy with nivolumab plus ipilimumab, associated with limited courses of chemotherapy, i.e. two instead of the ‘classic’ four or six, at the forefront of non-small cell lung cancer were also presented at the ASCO Congress. metastatic. In the CheckMate -9LA study, 27% of patients treated with this approach are alive at three years compared with 19% with chemotherapy alone.
“Too often the disease is discovered at an advanced stage and early diagnoses, eligible for surgery, do not exceed 25% – says Federico Cappuzzo, Director of Medical Oncology 2 at the Regina Elena National Cancer Institute in Rome -. The results of the CheckMate-816 study, which enrolled 358 patients, are truly significant and may now lead to a change in treatment guidelines at an early stage. To date, surgery is considered the only means of achieving definitive healing. However, between 30% and 55% of patients develop relapse after surgery, thus confirming a strong need for additional options. However, if the surgery is preceded by nivolumab plus chemotherapy, it is possible to obtain an important tumor regression and a potential curability of the patient “. The data presented, notes Cappuzzo, “show the extraordinary ability of neoadjuvant chemoimmunotherapy to reduce the risk of relapse by more than 80% in patients who obtain a complete pathological response. So can increase healings“. Furthermore,” the number of patients eligible for surgery is also increasing. Today, in fact, patients with inoperable non-metastatic disease are treated with chemoradiotherapy, but the impact of the CheckMate-816 study is such that it can lead to a change in the care of people with locally advanced disease, hitherto excluded from surgery “, Cappuzzo notes. If healing is a real goal in early-stage cancer, in metastatic pathology the therapies aim to improve long-term survival and chronicization. “At three years, 27% of patients treated in the first line with the dual immunoncological therapy, consisting of nivolumab plus ipilimumab, in association with two courses of chemotherapy, compared to 19% with chemotherapy alone “, explains Filippo de Marinis, Director of the Division of Thoracic Oncology of the European Institute of Oncology (IEO) of Milan. The data from the CheckMate -9LA study, on more than 700 patients, also refer to two subgroups traditionally with poor prognosis, ca characterized by low expression of the PD-L1 biomarker (less than 1%) and squamous histology. In the first case, overall survival at 36 months reached 25% compared to 15% with chemotherapy alone, in the second 24% compared to 11%. Therefore, the oncologists conclude, the value of this therapeutic scheme, reimbursed since last January also in Italy, is strengthened.
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