Skip to main content
  • Advertise
    Want to Advertise with Us?
    Conquer welcomes advertising and sponsorship collaborations with reputable companies offering high-quality products and services to people affected by cancer.
  • Affiliated Brands
    Academy of Oncology Nurse & Patient Navigators
    The Academy of Oncology Nurse & Patient Navigators (AONN+) is the largest national specialty organization dedicated to improving patient care and quality of life by defining, enhancing, and promoting the role of oncology nurse and patient navigators. Our organization of over 8,900 members was founded in May 2009 to provide a network for all professionals involved and interested in patient navigation and survivorship care services to better manage the complexities of the cancer care treatment continuum for their patients. We view our organization as one consisting of “professional patient advocates” and, to that end, we support and serve our members.
    Journal of Oncology Navigation & Survivorship
    The Journal of Oncology Navigation & Survivorship (JONS) promotes reliance on evidence-based practices in navigating patients with cancer and their caregivers through diagnosis, treatment, and survivorship. JONS also seeks to strengthen the role of nurse and patient navigators in cancer care by serving as a platform for these professionals to disseminate original research findings, exchange best practices, and find support for their growing community.
    The Oncology Nurse-APN/PA
    The Oncology Nurse-APN/PA (TON) provides coverage of the wide spectrum of oncology-related events, trends, news, therapeutics, diagnostics, organizations, and legislation that directly affect hematology/oncology nurses and advanced practitioners involved in healthcare delivery and product utilization. The scope and coverage include a unique presentation of news and events that are shaping the care of patients with cancer.
  • Healthcare Providers
  • Contribute

Immunotherapy Beneficial in Patients with Early-Stage Non–Small-Cell Lung Cancer and PD-L1 Expression

November 2021 – Lung Cancer

According to the American Cancer Society, more than 235,000 Americans are estimated to be diagnosed with lung cancer in 2021. Among these people, the majority, about 80% to 85%, of the patients will be diagnosed with the type of lung cancer known as non–small-cell lung cancer (NSCLC).

Important advances in drug therapy have increased survival for patients with lung cancer, and for the first time, there are signs that death rates from lung cancer are coming down, although lung cancer remains the number 1 cause of cancer-related death in the United States.

The introduction of the new generations of targeted therapies and immunotherapies has led to significant improvements in outcomes for patients with lung cancer. However, until now, immunotherapies have been mainly used in patients with advanced or metastatic (stage IV) NSCLC that has spread to other parts of the body.

Unmet Need for Patients with Early-Stage NSCLC

Although immunotherapies, especially the PD-1 and PD-L1 inhibitors, have significantly extended the survival of patients with advanced or metastatic NSCLC until recently, they have not been available for patients with earlier-stage (stage I-III) lung cancer, whose cancer often continues to relapse (come back) after treatment and often progresses to metastatic (spreading) cancer.

Enriqueta Felip, MD, PhD

“Up to 60% of patients with stage I-III NSCLC still experience disease relapse despite treatment with curative intent, demonstrating a high unmet medical need in this setting,” said Enriqueta Felip, MD, PhD, Head of the Lung Cancer Unit at Vall d’Hebron University Hospital in Barcelona, Spain, during the 2021 European Society for Medical Oncology (ESMO) Congress.

PD-1/PD-L1 Inhibitors in Advanced NSCLC

The majority of the PD-1 and PD-L1 inhibitors (or immunotherapies) have been approved for the treatment of patients with advanced or metastatic (stage IV) lung cancer, including Keytruda (pembrolizumab), Opdivo (nivolumab), Tecentriq (atezolizumab), and most recently, Libtayo (cemiplimab-rwlc).

Although the PD-L1 inhibitor Imfinzi (durvalumab) is approved for patients with stage III NSCLC, it is only approved for patients whose tumor cannot be removed by surgery (unresectable) and whose cancer has not progressed after concurrent radiation and chemotherapy.

In addition, Libtayo is also approved for earlier use in patients with locally advanced NSCLC who are not candidates for surgical removal of the tumor or for curative treatment with chemotherapy plus radiation.

Until very recently, no immunotherapy was approved for use in patients with early-stage lung cancer whose tumor was removed by surgery.

Benefits of Immunotherapy in Early Disease

Now, for the first time, the use of immunotherapy after surgical removal of the tumor and chemotherapy has shown benefits in patients with early-stage (stage IB-IIIA) NSCLC and PD-L1 expression.

In the recent study known as IMpower010, patients with early-stage NSCLC whose tumor had more than 1% PD-L1 expression on their tumor cells had shown benefit from the PD-L1 inhibitor Tecentriq, with the greatest benefit seen in patients with high (>50%) PD-L1 expression.

An interim analysis of the IMpower010 study previously demonstrated that treatment with Tecentriq after surgery and chemotherapy increased the time of disease-free survival (DFS) by 34% compared with best supportive care after surgery and chemotherapy.

Dr. Felip presented the results of an updated analysis at the latest ESMO Congress in early October, showing that in patients with PD-L1 expression of 1% or more, the use of Tecentriq increased the time of survival without signs of lung cancer compared with best supportive care.

“Atezolizumab [Tecentriq] is certainly stepping up as more effective therapy for this patient population,” Dr. Felip said.

IMpower010 compared the use of Tecentriq and best supportive care in 1,005 patients with early-stage (stage IB-IIIA) NSCLC after their tumor was removed by surgery, followed by up to 4 cycles of adjuvant (after surgery) chemotherapy.

Patients with high (≥50%) PD-L1 expression had the highest degree of benefit (34% improvement) from Tecentriq, which included reduction in disease recurrence (coming back) and death, and an intermediate benefit in patients with 1% to 49% PD-L1 expression. No benefit was seen in patients with NSCLC and no PD-L1 expression.

After an average follow-up of about 32 months, in almost half (44.7%) of the patients with stage IB-IIIA NSCLC and PD-L1 expression who received best supportive care the cancer came back, compared with a little more than one-quarter (29.4%) of the patients who received immunotherapy with Tecentriq.

The average time to the lung cancer coming back was 16.6 months in the patients who received Tecentriq compared with 10.9 months in the patients who received best supportive care.

Antonio Passaro, MD, PhD

“We are seeing results that will really move immunotherapy into early-stage disease,” said Antonio Passaro, MD, PhD, from the European Institute of Oncol­ogy in Milan, Italy, who commented on the study results at the ESMO meeting.

Practice-Changing Results

Dr. Passaro suggested that “The updated results from IMpower010 support the practice-changing outcomes from the interim DFS analysis and confirm the role of atezolizumab after adjuvant chemotherapy in patients with radically resected, early-stage NSCLC.”

“Results from this landmark study promise a potential paradigm shift in the treatment of patients with resected, early-stage NSCLC. They also shine important light on more effectively combating high-risk cancer in the early-stage setting before it spreads, as well as potentially preventing the disease recurrence,” concluded Dr. Felip.

New Treatment Approved for Early-Stage NSCLC

Based on these results, on October 15, 2021, the FDA accelerated the approval of Tecentriq for adjuvant treatment (after surgery and chemotherapy) of patients with early-stage (IB-IIIA) NSCLC and PD-L1 expression of 1% or more.

Key Points

  • Important advances in drug therapy have increased survival for patients with lung cancer
  • Until now, immunotherapies have been mainly used in patients with advanced or metastatic (stage IV) NSCLC
  • For the first time, the use of immunotherapy after surgical removal of the tumor and chemotherapy has shown benefits in patients with early-stage NSCLC and PD-L1 expression
  • Results from this study promise a paradigm shift in the treatment of patients with resected, early-stage NSCLC
  • Based on these results, in October, the FDA approved Tecentriq for adjuvant treatment of patients with early-stage NSCLC and PD-L1 expression

Recommended For You