Lung cancer is the world's most
deadly cancer, killing over 4000 people a day worldwide. Photo: Earth Times
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Lung cancer is the world's most deadly cancer, killing
over 4000 people a day worldwide. Only 15 per cent of those diagnosed
survive for five years or more, compared with 89 per cent of those with breast
common cancers evade detection by
silencing part of the immune system. Rather than
targeting tumours by destroying them through radiation or chemotherapy, it might
be possible to treat them by finding ways to reactivate
the immune system so it will destroy cancer cells itself.
drug designed to do this, nivolumab, has now been tested in 129 people for whom
other treatments had already failed. The group had non-small cell lung cancer
(NSCLC) – the most common form of the disease, accounting for 85 per cent of all
cases. Participants received either 1, 3, or 10 milligrams of nivolumab per
kilogram of bodyweight daily for up to 96 months.
Waking the immune system
way that cancer cells evade the immune system is by interacting with a molecule
on the surface of white blood cells called PD-1. Nivolumab blocks PD-1 so tumour
cells can't interact with it. This reawakens the immune system, allowing it to
attack the cancer.
two-year survival rate of the group on nivolumab was more than double that in a
group given standard therapies. "We found 1 in 4 patients alive at two years,
compared with 1 in 10 for conventional chemotherapy," says Michael Giordano,
head of oncology development at Bristol-Myers Squibb, the company behind
results were released this week ahead of the annual meeting of the American
Society of Clinical Oncology, which opens in Chicago at the end of May. A larger
trial of 500 people is now being organised.
separate trial involving 20 people hinted at why some with lung cancer respond
better to nivolumab than others. Those who had a molecule called PD-L1 present
in their tumour were significantly more likely to respond than those without it.
"This is an important finding, because there's a significant enrichment in the
likelihood of a response if patients are PD-L1 positive," says Giordano.
year, nivolumab was reported to produce dramatic
improvements in people with advanced malignant
melanoma . The Chicago meeting will hear of new, encouraging results from
melanoma trials: of 107 people treated with nivolumab at least three years ago
as a last resort, 48 per cent were alive at 2 years, with 41 per cent still
alive after three years. "We've gone from zero survival at three years to 40 per
cent," says Giordano. "That's very clear evidence of the value of immune-based
combination of nivulomab with another immunotherapy drug, called ipilimumab,
also developed by Bristol-Myers Squibb, is also working well in kidney cancer
that has spread to other organs.
Nivulomab is not the only PD-1 inhibitor being tested against lung cancer. At
the Chicago meeting, the drug company Merck will be presenting new results of
tests of its drug codenamed MK-347, and Roche will be releasing trial data on
how a similar immunotherapy agent, MPDL3280A, has performed in a trial of people
with bladder cancer.
data from these studies offer additional evidence that immunotherapy may play an
increasingly important role in cancer treatment options," says Maggie Callaghan
of the Memorial Sloan Kettering Cancer Center in New York, who was not involved
in the research.
results add to a growing body of evidence that throwing switches of the immune
system can have a profound effect on cancer," says Peter Johnson, chief
clinician at Cancer Research UK. He points out that cancer cells can out-evolve
and defy drugs targeted at particular mutations, but the immune system can
co-evolve and keep pace with the cancer. "If your immune system is working
properly, it will follow the tumour round the room," he says.
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