• A new study, supported by the National Cancer Institute and AstraZeneca, reports promise in treating people with non-small cell lung cancer with durvalumab, an immune checkpoint inhibitor drug.
• The study included participants with limited mobility, a population typically not included in clinical trials.
• While survival rates for people with lung cancer can be low, experts say the findings provide some hope.

A new study is reporting on the benefits of an immune checkpoint inhibitor drug in treating the most common form of lung cancer.

Researchers from the UPMC Hillman Cancer Center in Pittsburgh say that an immune checkpoint inhibitor known as durvalumab may help improve overall survival for people with advanced or metastatic non-small cell lung cancer (NSCLC).

The research, funded by the National Cancer Institute and the drug manufacturer AstraZeneca, was published this week in the medical journal The Lancet.

The study’s senior author went in-depth with Medical News Today on the significance of these findings while an outside expert hailed the study as groundbreaking.

Immune checkpoint inhibitors versus chemotherapy

Non-small cell lung cancer is the most common form of lung cancer and is the third-most common cancer overall in the United States.

Early detection and treatment boosts survival rates.

Immune checkpoint inhibitors such as durvalumab, which is sold under the brand name Imfinzi, work in essence by removing the brakes from the body’s immune system.

“It allows the release of checkpoints, so to speak, of a patient’s immune system and allows that patient’s own immune system to help their body fight the cancer,” explained Dr. Liza Villaruz, a senior study author and an associated professor of medicine at the University of Pittsburgh and co-leader of the Immunotherapy and Drug Development Center at UPMC Hillman.

These drugs differ significantly from chemotherapy – another common treatment for cancers – because chemotherapy attacks cancer cells directly while immune checkpoint inhibitors engage the immune system.

Early results show promise for lung cancer drug

Villaruz and her UPMC colleagues conducted a phase 2 trial on 50 people with advanced or metastatic NSCLC, all of whom were given durvalumab intravenously about once a month for up to 12 months.

There was no control group to compare to this population, but researchers said the findings were promising.

The median survival rates were 6 months in people with PD-L1-negative tumors and 11 months in people with PD-L1-positive tumors, numbers that compare favorably to platinum doublet chemotherapy.

Durvalumab has been approved by the U.S. Food and Drug Administration (FDA) as a treatment for cancer. This means that it’s already available for cancer treatment.

“I think this adds to the body of research – that is growing – in terms of exploring the efficacy of these FDA-approved therapies,” Villaruz told Medical News Today. “So this builds upon prior studies and it’s just the tip of the iceberg. When we have these newer types of therapies, novel therapies, I think one of the things that should always be considered is the applicability to real-world populations. It’s important to demonstrate the ability to give it safely to patients with borderline performance status.”

A wide range of lung cancer study participants

The trial differed from many medical trials for cancer drugs in that it assessed people with a wider range on the Eastern Cooperative Oncology Group, or ECOG, scale.

While many trials only assess people with lower ECOG scores, indicating better mobility and physical function, the UPMC Hillman study pulled data from people with a wider range of ECOG scores.

“These are patients who are a bit more compromised physically, in terms of their day-to-day activities,” Villaruz noted. “These patients traditionally would be excluded from a lot of the trials with checkpoint inhibitors that led to their FDA approval.”

Villaruz explained that many of the participants in the trial would be unable to make frequent visits to a testing hub, so she and her colleagues polled community clinics and rural and underserved areas of western Pennsylvania in order to assess a wider range of ECOG scores.

“The ability to enroll patients like this into a clinical trial and demonstrate safety is quite novel,” she said.

Dr. Wael Harb, a hematologist and medical oncologist at Orange Coast and Saddleback Medical Centers in California, told Medical News Today that the range of ECOG scores makes the findings very intriguing.

“I think the study is groundbreaking because it demonstrates that overlap of the safety and efficacy as a roadmap for first-line treatment for non-small cell lung cancer,” said Harb, who was not involved in the research. “Particularly in patients with ECOG performance status issues who have been excluded from clinical trials. It’s important to understand how treatments such as immunotherapy work in patients who might not tolerate chemotherapy very well. It really addresses a critical gap in current research.”

Understanding lung cancer

While NSCLC isn’t the only type of lung cancer, it’s by far the most prevalent, making up about 85% of cases in the United States.

Harb said that the most common cause is smoking, although the disease can happen in people who have never smoked.

Thanks to advances in immunotherapy, clinicians now have more options in their toolkit than chemotherapy alone, but lung cancer is still a difficult disease to treat.

“Unfortunately for a significant number of patients, by the time it’s diagnosed, they have incurable cancer,” Harb said. “We do have options for these patients including chemotherapy, but newer treatments like immunotherapy give us a map to help the immune system fight the cancer.”

While lung cancers have traditionally been grouped into two categories – non-small cell and small cell – Harb says that understanding is evolving quickly to provide a more nuanced understanding.

“Now we’re identifying tumors based on the molecular profiles, so we send the tumors for genomic analysis, analyze hundreds of genes, and discover if there are tumors harboring mutations,” he said. “We have treatments for maybe a handful of them, but the goal is that we would develop a treatment for every single one of these mutations.”

“As our understanding of lung cancer becomes more refined, we could no longer be talking about the type of cancer, but the specific type of tumor, which could help us understand and develop targeted treatment,” Harb explained.

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