Immunotherapy for early lung cancer was used

"5 out of 7 cases showed CR"

National Cancer Center, Professor Lee Geon-guk, Department of Pathology, Professor Ahn Byung-Cheol, Department of Hematology-Oncology

“Feeling the effect of immuno-anticancer drugs at the clinics/ improving patient treatment prognosis”

Lung cancer with high recurrence risk, consider using adjuvant therapy

As immuno-anticancer drugs can be used in early lung cancer, the prognosis of patients is improving.

 

Unlike before, when chemotherapy and concurrent chemoradiation were all, it is evaluated that the number of cases of 'complete pathological remission' has increased.

 

Opdivo was approved by the Ministry of Food and Drug Safety in October of last year for adjuvant therapy before non-small cell lung cancer surgery.

 

This is the first case in which immuno-oncology drugs have advanced into adjuvant therapy before surgery.

 

Specifically, Opdivo can be used along with chemotherapy in non-small cell lung cancer patients with tumors larger than 4 cm or with positive lymph nodes.

 

The treatment proceeds by using 3 cycles of Opdivo + chemotherapy and undergoing surgery.

 

Prof.

 

Lee Kun-guk (left), Prof.

 

Ahn Byeong-cheol (right), National Cancer Center

Lee Kun-Guk, a professor of pathology at the National Cancer Center, gave a positive evaluation, saying, "The introduction of immuno-anticancer drugs has greatly increased the number of cases of pathological CR, which were rarely seen before." "CR was observed in 5 out of 7 cases at our hospital.

 

Through a conversation with Professor Lee and Professor Ahn Byeong-Cheol of the Department of Hematology and Oncology at the National Cancer Center, Daily Pharm examined the changes brought about by the advent of immuno-anticancer drugs in adjuvant therapy before lung cancer surgery.

 

-We know that the way to expect a complete cure for early lung cancer is through surgical treatment.

 

What is the percentage of patients who can undergo surgery by stage?

 

There are cases of recurrence even after surgery.

 

What if there has been an unmet need?

 

=Professor Ahn Byeong-Cheol (referred to as Professor Ahn): Looking at each stage, 80% of stage 1, 60% of stage 2, and 50% of stage 3A can be operated.

 

It is known that all stages 1 to 3A can be operated, but not all patients can operate because of the complex effects of various factors, such as the patient's psychological burden for surgery and the state of the disease, in addition to the stage.

 

Lung cancer is a carcinoma with a high recurrence rate, with studies showing that even stage 1 patients recur up to 40%.

 

Three out of four patients with stage 3 disease with a high stage show recurrence.

 

Therefore, there has always been an unmet need for therapies that can reduce the recurrence rate and improve the prognosis.

 

There have been many attempts to increase the success rate of surgery by reducing the size of the tumor as an adjuvant therapy before surgery for patients with a difficult surgery.

 

However, chemotherapy, which was a representative preoperative adjuvant therapy, did not show a therapeutic effect to such an extent that the pathological CR ratio remained in the single digits.

 

Simultaneous chemoradiation had limitations due to toxicity and side effects such as pneumonia, decreased lung function, and adhesions.

 

-Recently, immuno-anticancer drugs appeared in adjuvant therapy before lung cancer surgery in combination with chemotherapy.

 

I am curious to see how much treatment has been achieved with the experience of actually prescribing this therapy.

 

=Professor Lee Kun-Guk (Professor Lee): So far, immunotherapy was used as an adjuvant therapy before surgery in 7 cases, and in 5 of them, so-called pathological CR, in which lung cancer was not found, although lumps remained, could be confirmed.

 

Certainly, it shows a significantly improved treatment effect compared to previous preoperative adjuvant therapy.

 

Previously, pathological CR was rarely reached.

 

Therefore, it was difficult to evaluate the treatment effect.

 

If complete pathological remission is frequently achieved, as in the combination of Opdivo and chemotherapy, a significant part of the worry can be relieved from the perspective of medical staff.

 

If it is confirmed that there is no cancer mass when observed under a microscope, a lot of burdens is relieved for pathologists who have to quantify the treatment effect.

 

-Are there any concerns about missing the right time for surgery when treated with adjuvant therapy before surgery?

 

=Professor Ahn: I think it is homework to be solved in the preoperative adjuvant treatment.

 

Statistically, less than 10% of patients who were able to undergo surgery may miss the timing due to adjuvant therapy before surgery and may not be able to undergo surgery.

 

However, the ratio of patients who underwent surgery in clinical trials with this immunotherapy was 83.2%, higher than 75.4% of the chemotherapy alone group.

 

Ultimately, I think it is important for medical staff to select and treat patients who are suitable for preoperative adjuvant therapy.

 

-Opdivo + chemotherapy combination therapy has been approved for use regardless of the PD-L1 expression rate and major gene mutations.

 

Is there any difference in actual effect?

 

=Professor Ahn: The higher the PD-L1 expression rate, the higher the therapeutic effect of immuno-anticancer drugs.

 

The higher the PD-L1 expression rate, the lower the risk of recurrence and the higher the pathological complete response rate.

 

However, since it showed a significant improvement effect in all patient groups regardless of the PD-L1 expression rate, it is prescribed regardless of the actual clinical setting.

 

=Professor Lee: In patients with target gene mutations, the effect of immuno-anticancer drugs is relatively low, and a follow-up study on this is likely to be necessary.

 

However, I think it is meaningful in that the opportunity for adjuvant therapy before immuno-oncology surgery is open to all patients.

 

-It is expected that the importance of pathological examination will be further emphasized in lung cancer treatment.

 

What do you think the pathological diagnosis system needs to change in the future?

 

=Professor Lee: I think the pathology examination fee needs to be improved.

 

About 400 genes are identified by the NGS test at medical institutions, and the fee is 1.5 million won based on the main hospital, which is a secondary hospital.

 

This is a very small amount compared to about 6 million won in the United States.

 

In Korea, the number of genes required to be tested is low compared to the number of genes that need to be tested, making it difficult for NGS testing to be universalized.

 

Personally, I think NGS testing will become more common in more hospitals if NGS testing is lightweight and appropriately priced so that only necessary genes are tested rather than testing all 400 genes.