Three new advances are set to transform lung cancer treatment – turning the tide on a disease that is often considered a death sentence. Someone in the UK is diagnosed with lung cancer every ten minutes – amounting to roughly 50,000 new patients each year – and just a quarter survive five years. Some 35,000 die of it annually, making it our biggest cancer killer.
But this weekend, doctors treating it had much to celebrate as a range of highly effective new therapies were unveiled at the American Society for Clinical Oncology (ASCO) conference in Chicago.
Over the past few decades, research has taken huge leaps forward in tackling other common forms of the disease, such as breast, prostate and bowel cancer – and, most recently, new targeted treatments for the ‘once hopeless’ melanoma skin cancer has seen patients effectively cured.
Experts say they are tantalisingly close to a similar breakthrough with lung cancer.
‘When I became a doctor, no one wanted to specialise in lung cancer because – for most patients – it was a death sentence and we had no treatments to stop it,’ says James Spicer, Professor of Experimental Cancer Medicine at King’s College London.
Three new advances are set to transform lung cancer treatment – turning the tide on a disease that is often considered a death sentence
‘Now new drugs mean that even patients whose cancer has spread around the body are living for ten, even 15, more years.
‘We’re at a point where we’re beginning to talk about cures for these advanced patients.’
Perhaps the greatest excitement was for those with early-stage lung cancer, who could soon be given a high-tech drug that boosts the immune system, after a ground-breaking study found the treatment significantly slows the return of the disease.
The injection, called pembrolizumab, helps the immune system spot hidden cancer cells in the body. It is currently only offered to NHS patients with advanced lung cancer whose disease has spread. But the treatment could now be offered to thousands more.
Researchers at Stanford University in California have found that, when taken alongside chemo in the three months before surgery and then for a year afterwards, pembrolizumab significantly reduced the risk of early-stage lung cancer returning, compared to a course of chemo prior to the operation.
Perhaps the greatest excitement was for those with early-stage lung cancer, who could soon be given a high-tech drug that boosts the immune system, after a ground-breaking study found the treatment significantly slows the return of the disease
On average, patients on the new treatment were still cancer-free after nearly a year, while those who only received chemo were only free of the disease for four months.
Although smoking-related lung cancer is on the decline as more people quit the habit, non-smoking related lung cancer is on the rise, for reasons not fully understood.
The trial included patients with non-small cell lung cancer, the most common form of the disease, which accounts for around 80 per cent of new lung cancer cases.
While researchers in the trial said it is too early to report the exact numbers of extra months patients on pembrolizumab are expected to live, experts say early signs are incredibly positive.
‘The data we have seen shows that, if you’re on this treatment, you’re half as likely to see your cancer return,’ says Prof Spicer.
‘That is hugely positive for these patients, who can expect to live much longer as a result. The study also shows that, in some cases, researchers were unable to find any signs of cancer at all. These patients are effectively cured.’
Pembrolizumab is what is known as a checkpoint inhibitor, which helps the immune system spot tumour cells and destroy them.
Given by injection every three weeks, it has already proved a remarkably successful treatment in patients with melanoma skin cancer, bladder cancer and lymphoma. Experts say it is likely the new regime will become a routine treatment for lung cancer patients on the NHS. ‘The data show that giving pembrolizumab alongside chemo can reduce the risk of relapse in all patients with this form of lung cancer,’ says Prof Spicer. ‘This will soon be the standard of care on the NHS.’
The injection, called pembrolizumab, helps the immune system spot hidden cancer cells in the body. It is currently only offered to NHS patients with advanced lung cancer whose disease has spread. But the treatment could now be offered to thousands more
Expert say the next step will be to see if the number of pembrolizumab injections can be reduced.
‘This drug appears to buy people more time but patients still need to regularly come into hospital for their treatment,’ says Professor Jyoti Patel, a cancer clinical research expert at Northwestern University, Illinois. ‘These immunotherapy drugs are not without side-effects either and they can increase the risk of other diseases because they impact the immune system.
‘Future trials need to look at whether we can de-escalate treatment, so patients receive fewer doses and have fewer side-effects as a result.’
Another challenge is spotting lung cancer early enough to be able to offer patients this new treatment. Studies show that, currently, only around a fifth of lung cancer cases are picked up in the early stages.
Speaking at the ASCO conference, the lead researcher on the trial, Dr Heather Wakelee, chief of the division of oncology at Stanford University, called for more research into lung cancer screening. ‘Without screening we cannot find patients with early-stage disease,’ she said. ‘It’s important we keep pushing a lot of effort towards improving screening.’
But experts say an NHS lung cancer screening programme is already close at hand.
In Manchester, a ‘Lung Health Check’ is offered to all aged 55 to 74 who smoke or used to smoke. ‘This could expand across the NHS,’ says Prof Spicer.
If approved on the NHS, pembrolizumab may be joined by another drug.
A trial due to be presented at the ASCO conference tomorrow is expected to show that the immune-boosting drug osimertinib, created by UK firm Astrazeneca, significantly improves the survival time of non-small cell lung cancer sufferers with a specific genetic mutation called EGFR.
While this mutation is only carried by 15 per cent of lung cancer patients, experts believe this figure will increase in coming years as it is linked with cases of non-smoking related lung cancer which are rising.
Studies suggest these cases may be linked to pollution. Osimertinib is only available on the NHS for patients with the EGFR mutation whose disease has spread into other organs.
Experts are also excited by another lung cancer drug presented to the ASCO. Known as SKB264, it has been dubbed ‘a warhead drug’ as it can penetrate tumours, delivering a powerful ‘payload’ of chemotherapy agents that attack cancer cells from the inside.
The highly accurate treatment, known medically as an antibody drug conjugate, avoids harming healthy tissue, meaning doctors can give higher doses without worsening side-effects.
In a trial involving 43 patients with advanced lung cancer which had returned after surgery and conducted by Chinese drug developer Kelun, SKB264 was shown to reduce the size of lung cancer tumours in around 45 per cent of participants.
Dr Heather Wakelee, chief of the division of oncology at Stanford University, called for more research into lung cancer screening. ‘Without screening we cannot find patients with early-stage disease,’ she said. ‘It’s important we keep pushing a lot of effort towards improving screening’
For this group, chemo only works in around 20 per cent of patients and remains effective for fewer than four months.
Patients who responded to SKB264 saw their tumours kept under control for more than nine months. Experts say this means that SKB264 could potentially double the survival time for this patient group.
Experts say warhead drugs like SKB264 could soon be combined with immunotherapy and chemo to extend lung cancer patients’ lives further.
‘Antibody drug conjugates deliver toxic drugs directly to tumours,’ says Prof Spicer. ‘Only 20 per cent of lung cancer patients are effectively cured. Antibody drug conjugates could raise that number.’