Nivolumab And Chemotherapy For Early Stage Lung cancer
Lung cancer is the most often diagnosed cancer globally. According to the Journal of Thoracic Oncology, lung cancer accounts for 5.9% of all malignancies and 8.1% of all cancer-related deaths. When lung cancer is detected before it has spread beyond the lungs, the tumor is usually removed by surgery. Unfortunately, even when cancer is detected early and all tumors are removed by surgery, cancer often returns.
NSCLC, or Non-small cell lung cancer, is the most prevalent. The standard treatment for people with NSCLC is a lobectomy, followed by systemic adjuvant therapy. Instead of this standard treatment, advanced or novel techniques are used to lower the chance of recurrence and enhance NSCLC survival. Recent studies have shown that combination treatment with an immunotherapy drug, Nivolumab and chemotherapy before surgery can significantly stop the spread or recurrence of cancer.
Please Keep Reading To Learn More About Early Lung Cancer Medication And Treatment.
Treatments For Early Stage Lung Cancer
Generally, more than one treatment is typically involved in fighting cancer. Most treatment plans involve surgery or radiation therapy with added adjuvant and/or neoadjuvant therapy. Therapies, like chemotherapy, are advised before or after the primary treatment to increase the chance of success of the treatment and decrease the risk of recurrence.
Neoadjuvant and adjuvant therapies, the two therapies differ largely in when and what they are given. After the primary treatment, adjuvant therapies are given to destroy remaining cancer cells. And neoadjuvant therapies are given before the main treatment, which helps in reducing the size and spread of a tumor.
Neoadjuvant Therapy
Neoadjuvant treatment is another approach to improve survival in non-small cell lung cancer patients. Trials have been done with both Nivolumab with chemotherapy combination and chemotherapy alone in patients with early-stage lung cancer. Patients who received this combination lived longer without experiencing significant events, such as cancer recurrence.
Neoadjuvant treatment offers several potential advantages, including downstaging of the tumor. It allows complete resection, early treatment of micrometastases, and improved tolerability.
Nivolumab
Although most lung cancer cases in India are found at an advanced stage, standard cancer treatments are only moderately effective. Nivolumab has shown the highest treatment success rates compared to other treatments for early-stage lung cancer. Nivolumab is given either as a single drug or in combination with other drugs for treating adult patients with metastatic or unresectable melanoma, in treatment of adult melanoma after complete resection with lymph node involvement or metastatic disease, and also in non-small cell lung cancer combined with platinum-doublet chemotherapy.
Nivolumab And Platinum-Doublet Chemotherapy - Neoadjuvant Therapy
The FDA (Food and Drug Administration) approved nivolumab with platinum-doublet chemotherapy for resectable non-small cell lung cancer (NSCLC) in adult patients. Nivolumab, a PD-1 (fully human anti–programmed death 1) antibody, works by restoring the function of antitumor T cells existing in the body, and chemotherapy improves the antitumor immunity by directly or indirectly activating the immune system. This combination treatment of Nivolumab chemotherapy has shown an increased survival rate in patients with metastatic NSCLC. This neoadjuvant therapy helps to treat micrometastatic disease by enhancing the immune response even in the presence of bulk tumors or tumor antigens during the treatment.
In phase 2, clinical studies of resectable NSCLC, neoadjuvant nivolumab with chemotherapy showed progress with respect to pathological response, safety profiles, and survival outcomes. Studies showed about 81.9% of 3-year overall survival and 69.6% of progression-free survival among patients who received neoadjuvant nivolumab and chemotherapy for resectable stage IIIA NSCLC.
In an open-label, phase III, CheckMate 816 study, a 1:1 ratio of patients with stage IB to IIIA resectable NSCLC were randomly assigned by the investigators to receive nivolumab plus platinum-based chemotherapy (three cycles) or platinum-based chemotherapy alone (three cycles), followed by resection. The authors commented that neoadjuvant therapy shows a significantly longer survival rate with a complete pathological response in a higher percentage of patients when compared to chemotherapy alone treatment in patients with resectable NSCLC.
Side Effects Of Nivolumab Chemotherapy Treatment
The most common adverse reactions (incidence ≥20%) occurring in patients were nausea, constipation, fatigue, decreased appetite, and rash. This neoadjuvant therapy did not result in more frequent delays or cancellations of surgery. However, the median lengths of hospital stay following definitive surgery and the rates of adverse reactions identified as surgical complications were similar for patients in both arms of the trial.
Safety was consistent with this treatment and did not result in a greater rate of severity in adverse events than chemotherapy alone. The combination of Nivolumab chemotherapy does not increase surgery-related adverse events or impede the feasibility of surgery.
Better clinical outcomes with nivolumab plus chemotherapy were observed in most cases with stage IIIA than in those with stage II or IB disease. Longer follow-ups may be required to capture the health benefits of nivolumab chemotherapy combination treatment in patients at early disease stages.
Discussion
Data shows that 3 cycles of neoadjuvant nivolumab chemotherapy treatment improved long-term clinical outcomes with respect to complete pathological response and event-free survival It had resulted in no greater severity in adverse effect does or impede the feasibility of surgery in patients with resectable stage IIIA and IB NSCLC. On the basis of this trial, the nivolumab chemotherapy combination has been approved by FDA as a neoadjuvant treatment for adult patients with resectable NSCLC. Overall, it has been shown that neoadjuvant nivolumab plus chemotherapy has been demonstrated to provide positive outcomes and improve the long-term survival of lung cancer patients over chemotherapy alone therapy.
