Some lung cancer patients benefit from immunotherapy even after disease progression

May 5, 2017, European Society for Medical Oncology

Some advanced lung cancer patients benefit from immunotherapy even after the disease has progressed as evaluated by standard criteria, according to research presented at the European Lung Cancer Conference (ELCC).1 The findings pave the way for certain patients to continue treatment if the disease is not progressing according to new, more specific, criteria.

The Response Evaluation Criteria in Solid Tumours (RECIST) evaluates changes in size and identifies whether are responding to or progressing. An enlarging tumour on a CT scan signals that patients are progressing, and treatment is changed to best supportive care or a different drug. Immune-related RECIST was developed to account for the fact that tumours enlarge temporarily in patients taking .

"Immunotherapy causes lymphocytes, the white blood cells that fight against tumour cells, to infiltrate the tumour leading to a transient increase in size," said lead author Dr Angel Artal-Cortes, Medical Oncologist, University Hospital Miguel Servet, Zaragoza, Spain. "With chemotherapy, tumour enlargement indicates that the tumour is growing and the disease is progressing."

The study presented today is a of the phase 2 POPLAR trial, which randomised patients with non-small cell lung cancer (NSCLC) who had progressed on platinum-based chemotherapy to second-line treatment with the anti-programmed death ligand 1 (PD-L1) antibody atezolizumab or chemotherapy with docetaxel. Response to treatment was assessed with RECIST and immune-related RECIST criteria. As previously reported, atezolizumab significantly improved survival compared with docetaxel.2

The study protocol allowed patients to continue atezolizumab treatment if they had not progressed according to immune-related RECIST and had no major toxicities, even if conventional RECIST indicated progression. The post hoc analysis evaluated overall survival and performance status in the 61 patients who continued atezolizumab after standard progression. The investigators found that the tumours in 82% of these patients subsequently stabilised or shrank. Median overall survival was 11.8 months and objective response rate increased when immune-related RECIST was used.

Artal-Cortes said: "We found that there was a benefit for some patients continuing with the drug even after a CT scan suggested progressive disease. Atezolizumab can control for a longer period of time than was initially thought. Patients who were maintained on atezolizumab had no major increase in toxic side-effects since most of these occur in the first few months."

He concluded: "Our results suggest that immune-related RECIST should be kept in mind to decide whether or not to continue atezolizumab treatment in patients who are responding to the drug, have a good performance status, no serious toxicities from the drug, and no major symptoms from the tumour."

Commenting on the research, Marina Garassino, MD, Head of Thoracic Medical Oncology, National Cancer Institute of Milan (Fondazione IRCCS Istituto Nazionale dei Tumori), Italy, said: "This study shows that conventional RECIST may not be the best criteria to evaluate response to immunotherapy. It found that immune-related RECIST better predicted outcome with immunotherapy than RECIST."

"The research suggests that immunotherapy can be prolonged when the new criteria are used," she added. "Patients continuing atezolizumab based on immune-related RECIST benefited from the drug even though it was a progressive disease by the RECIST criteria. This was a post hoc analysis of a phase 2 trial and so the results need to be confirmed in other studies."

Explore further: Triple-negative breast cancer patients who responded to immunotherapy had long-term survival benefit

More information: 1 Abstract 96PD - 'Evaluation of non-classical response by immune-modified RECIST and efficacy of atezolizumab beyond disease progression in advanced NSCLC: results from the randomized Phase II study POPLAR' will be presented by Dr Angel Artal-Cortes during the Poster Discussion session 'Epidemiology and innovations in biomarker development': on Saturday, 6 May, 16:45 (CEST).

2 Fehrenbacher L, et al. Atezolizumab versus docetaxel for patients with previously treated non-small-cell lung cancer (POPLAR): a multicentre, open-label, phase 2 randomised controlled trial. Lancet. 2016;387(10030):1837-1846. DOI: 10.1016/S0140-6736(16)00587-0. Epub 2016 Mar 10.

Related Stories

Triple-negative breast cancer patients who responded to immunotherapy had long-term survival benefit

April 3, 2017
Among patients with metastatic triple-negative breast cancer (TNBC) who were treated with the anti-PD-L1 cancer immunotherapy atezolizumab (Tecentriq), those who responded to the medicine lived significantly longer (overall ...

Immunotherapy drug gives non-small-cell lung cancer patients extra four months of life

December 13, 2016
Patients with advanced non-small-cell lung cancer survive four months longer with fewer side effects on an immunotherapy drug called atezolizumab compared to chemotherapy, according to a phase 3 clinical trial published in ...

White blood cell count predicts response to lung cancer immunotherapy

May 4, 2017
White blood cell counts can predict whether or not lung cancer patients will benefit from immunotherapy, according to research presented at the European Lung Cancer Conference (ELCC).

Atezolizumab set to change refractory lung cancer treatment

September 28, 2015
Atezolizumab is set to substantially change treatment strategies for patients with refractory lung cancer, according to Dr Martin Reck, Chief Oncology Physician in the Department of Thoracic Oncology, Hospital Grosshansdorf, ...

Significant survival gains with atezolizumab vs docetaxel for non-small-cell lung cancer

October 9, 2016
The first phase III study of PD-L1 inhibitor atezolizumab in previously-treated non-small-cell lung cancer has seen significant improvements in survival compared to standard chemotherapy, researchers reported today at the ...

Greater patient selection may be needed for first line nivolumab to improve progression-free survival

October 11, 2016
Greater patient selection may be needed for first line nivolumab to improve progression-free survival over chemotherapy in advanced lung cancer as the CheckMate 026 trial gave negative results in a broad group of patients ...

Recommended for you

Research team discovers drug compound that stops cancer cells from spreading

June 22, 2018
Fighting cancer means killing cancer cells. However, oncologists know that it's also important to halt the movement of cancer cells before they spread throughout the body. New research, published today in the journal Nature ...

Dying cancer cells make remaining glioblastoma cells more aggressive and therapy-resistant

June 21, 2018
A surprising form of cell-to-cell communication in glioblastoma promotes global changes in recipient cells, including aggressiveness, motility, and resistance to radiation or chemotherapy.

Existing treatment could be used for common 'untreatable' form of lung cancer

June 21, 2018
A cancer treatment already approved for use in certain types of cancer has been found to block cell growth in a common form of lung cancer for which there is currently no specific treatment available.

Novel therapy makes oxidative stress deadly to cancer

June 21, 2018
Oxidative stress can help tumors thrive, but one way novel cancer treatments work is by pushing levels to the point where it instead helps them die, scientists report.

Higher body fat linked to lower breast cancer risk in younger women

June 21, 2018
While obesity has been shown to increase breast cancer risk in postmenopausal women, a large-scale study co-led by a University of North Carolina Lineberger Comprehensive Cancer Center researcher found the opposite is true ...

Researchers uncover new target to stop cancer growth

June 21, 2018
Researchers at the University of Wisconsin-Madison have discovered that a protein called Munc13-4 helps cancer cells secrete large numbers of exosomes—tiny, membrane-bound packages containing proteins and RNAs that stimulate ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.