During the first weekend in June, dedicated lung cancer professionals (including a strong representation from members of LUNGevity’s Scientific Advisory Board and LUNGevity research grant awardees) came together at the American Society of Clinical Oncology (ASCO) conference in Chicago to present and discuss the implications of important data from the latest cancer research.
ASCO hosted approximately 40,000 attendees from the U.S. and around the world, including oncologists, scientists, biotech and pharmaceutical representatives, advocacy groups, and patients. The theme for this year’s conference recognized the growing importance of precision medicine and the growing impact of patient advocates: “Caring For Every Patient, Learning From Every Patient.”
Researchers presented data on different aspects of lung cancer detection, treatment, and prevention. Here we highlight some of the most impactful and interesting studies that were presented.
Effect of ACA on Cancer Care in African Americans
The disparity in healthcare access between African Americans and whites is well documented. This disparity has extended to healthcare for those with cancer. A study presented at ASCO looked at the electronic health records of 30,000 patients to determine the effect of Medicaid expansion from the Affordable Care Act (ACA) on timely access to cancer treatment. The data showed that the Medicaid expansion effectively closed the gap between African Americans and whites in the timely receipt of cancer treatment; in addition, African American patients benefited more than white patients in receiving care within 30 days. The effectiveness of the ACA in reducing this disparity offers a possible path forward to improving healthcare access for other underserved populations.
Eligibility Criteria for Clinical Trials
Researchers conducted a retrospective study of more than 10,000 patient case files to determine whether expanding the criteria for participation in clinical trials involving patients with advanced non-small cell lung cancer (NSCLC) would improve eligibility. They found that by allowing patients with brain metastases, previous or concurrent cancers, and limited liver function to participate, the percentage of patients eligible for clinical trials would increase from approximately 52% to 98%. This research presented at ASCO complements LUNGevity Foundation’s endeavors to streamline lung cancer clinical trials and make them more patient-centric. One of LUNGevity’s initiatives, the Scientific and Clinical Roundtables, focuses on expanding eligibility criteria, such as reducing the exclusion of lung cancer patients with brain metastasis and low performance status. It was exciting to see efforts to make trials more accessible. Ongoing research is needed to look at outcomes of subgroups of NSCLC patients in clinical trials to determine how to safely implement expanded eligibility criteria.
In the last few years, there has been impressive progress in the field of immunotherapy, which uses treatments that harness the body’s natural immune system to fight off cancer and other diseases. Physicians treating advanced NSCLC and small cell lung cancer patients now have the option of immunotherapies to consider when deciding on the best course of treatment for their patients.
Dr. Edward Garon, director of the Thoracic Oncology Program at the Jonsson Comprehensive Cancer Center at UCLA and member of LUNGevity’s Scientific Advisory Board, presented the 5-year survival data of KEYNOTE-001, an important clinical trial looking at pembrolizumab in patients with advanced NSCLC. Before researchers developed immunotherapy for lung cancer patients, only 5% of patients with advanced NSCLC survived for five years. The findings presented at ASCO showed that 23% of patients who were not initially treated with chemotherapy and 15% of patients who were initially treated with chemotherapy were still alive after five years on pembrolizumab. Patients with high levels of the protein PD-L1 benefited the most. These data demonstrate the remarkable potential of immunotherapy for advanced NSCLC patients.
The phase III Impower130 clinical trial looked at the effect of adding an immunotherapy drug, atezolizumab, to a chemotherapy regimen of cisplatin and nab-paclitaxel in patients with stage IV non-squamous NSCLC who didn’t have EGFR or ALK mutations. The data showed that, regardless of the levels of the protein PD-L1, patients who received first-line immunotherapy combined with chemotherapy had a median overall survival The length of time from either the date of diagnosis or the start of treatment for a disease, such as cancer, that patients diagnosed with the disease are still alive. of 18.6 months, compared to 13.9 months in patients who received first-line chemotherapy alone. These data strongly suggest that first-line immunotherapy combined with chemotherapy could become a good option for this group of patients.
Research is continuing in the immunotherapy field to determine which lung cancer subgroups should and should not be given immunotherapy. Scientists are also studying different treatment combinations and personalized immunotherapies to optimize treatment regimens. Additional immunotherapy studies are working to overcome drug resistance in relapsed patients.
This ASCO was a biomarker-filled conference–with readouts from several clinical trials using drugs that target mutations in genes such as KRAS, HER2, and MET. While we have consistently seen progress in the area of targeted therapies, the new clinical trial using AMG 510, which targets a specific type of KRAS mutation–the G12C mutation–is a major development. Though mutations in the KRAS gene have been untargetable to date, these new clinical data show that scientists are finally cracking this nut!
The phase III RELAY clinical trial looked at the effect of combining erlotinib, a first-generation EGFR TKI inhibitor, with ramucirumab, a VEG-FR pathway inhibitor, on NSCLC patients with EGFR mutations. This study followed the outcomes of 449 previously untreated patients. Patients given the combination treatment showed a median progression-free survival of 19.4 months compared to 12.4 months with erlotinib alone. This result indicates that inhibiting the VEG-F pathway and the EGFR pathway simultaneously demonstrates a benefit for patients with EGFR mutations.
Some patients with advanced non-squamous NSCLC have risk factors, such as interstitial lung disease or rheumatologic lung disease, that make it unadvisable for them to be treated with first-line immunotherapy. In these cases, it has been common practice for patients to be treated with the combination of bevacizumab with carboplatin and pemetrexed. However, there has been little formal evidence to show that adding bevacizumab to chemotherapy actually improves patient outcomes. To address this uncertainty, researchers at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia studied the healthcare records of more than 4,700 patients with advanced non-squamous NSCLC to determine if adding bevacizumab to chemotherapy is beneficial. The findings of this study confirmed that adding bevacizumab to a carboplatin and pemetrexed regimen in these patients improves the overall survival outcomes compared to carboplatin and pemetrexed alone.
The ECOG-ACRIN 5508 clinical trial was a phase III study to determine the optimal maintenance therapy for non-squamous NSCLC patients. The 1,000+ patients who were enrolled in this trial were treated with four cycles of carboplatin and paclitaxel with bevacizumab. Those patients with stable disease after treatment were randomized into three groups for maintenance therapy: bevacizumab alone, pemetrexed alone, or a combination of bevacizumab and pemetrexed. The results revealed that using either bevacizumab or pemetrexed alone as maintenance therapy is preferred, as the combination approach showed increased toxicities without significantly improved outcomes.
The results of all the lung cancer studies presented at ASCO and the overall increase of therapeutic options for lung cancer patients is a testament to the hard work of physicians, scientists, patients, advocacy groups, medical staff, and policymakers working to make lung cancer patients a priority. Progress continues.
Juhi Kunde, MA, is a science writer for LUNGevity.