Lung Cancer Outcomes Significantly Improved with Immunotherapy-Based Treatment Given Before and After Surgery

A regimen of pre-surgical immunotherapy and chemotherapy followed by post-surgical immunotherapy significantly improved event-free survival (EFS) and pathologic complete response (pCR) rates compared to chemotherapy alone for patients with operable non-small cell lung cancer (NSCLC), according to results of a Phase III trial.

The trial evaluated durvalumab given perioperatively, meaning therapy is given both before and after surgery. Participants on the trial received either pre-surgical (neoadjuvant) durvalumab and platinum-based chemotherapy followed by post-surgical (adjuvant) durvalumab or neoadjuvant placebo and chemotherapy followed by adjuvant placebo.

AEGEAN was the first Phase III trial investigating perioperative immunotherapy in patients with resectable NSCLC to report positive outcomes, and these data add to the growing evidence supporting the benefits of both neoadjuvant and adjuvant immunotherapy for these patients

Of the patients receiving perioperative durvalumab, 17.2% had a pCR compared to just 4.3% of those receiving chemotherapy alone. At the first interim analysis of EFS, with a median follow-up of 11.7 months, the median EFS was 25.9 months in the placebo arm, but it had not yet been reached in the durvalumab arm.

These data correspond to a 32% lower chance of patients experiencing disease recurrence, progression events or death with the immunotherapy-based treatment when compared to chemotherapy alone. Approximately four times as many patients treated with perioperative durvalumab plus chemotherapy achieved a pCR when compared to those treated with chemotherapy alone.

Durvalumab, an immune checkpoint inhibitor targeting PD-L1, has previously been approved for treating specific patients with biliary tract cancer, liver cancer, small cell lung cancer and NSCLC. Currently, durvalumab is used for treating patients with locally advanced, unresectable NSCLC following definitive chemoradiotherapy and for patients with metastatic NSCLC in combination with tremelimumab and platinum-based chemotherapy.

Overall, the treatments were well tolerated, and side effects were consistent with previous studies. The researchers observed maximum grade 3-4 any cause of adverse events in 42.4% and 43.2% of patients on the durvalumab and placebo arms, respectively.

The benefits in both pCR and EFS largely were consistent across predefined patient subgroups, and the trial continues assessment for long-term EFS as well as disease-free survival and overall survival outcomes.

Heymach explained that future studies must determine which patients receive the most benefit from neoadjuvant therapy and may be able to avoid further treatment as well as those who remain at high risk of recurrence and may require more intensive adjuvant regimens.

Sources:

John V. Heymach, David Harpole, Tetsuya Mitsudomi, Janis M. Taube, Gabriella Galffy, Maximilian Hochmair, Thomas Winder, Ruslan Zukov, Gabriel Garbaos, Shugeng Gao, Hiroaki Kuroda, Gyula Ostoros, Tho V. Tran, Jian You, Kang-Yun Lee, Lorenzo Antonuzzo, Zsolt Papai-Szekely, Hiroaki Akamatsu, Bivas Biswas, Alexander Spira, Jeffrey Crawford, Ha T. Le, Mike Aperghis, Gary J. Doherty, Helen Mann, Tamer M. Fouad, Martin Reck. Perioperative Durvalumab for Resectable Non–Small-Cell Lung Cancer. New England Journal of Medicine, 2023; DOI: 10.1056/NEJMoa2304875

Materials provided by University of Texas M. D. Anderson Cancer Center. Note: Content may be edited for style and length.

University of Texas M. D. Anderson Cancer Center. “Lung cancer outcomes significantly improved with immunotherapy-based treatment given before and after surgery.” ScienceDaily. ScienceDaily, 23 October 2023. <www.sciencedaily.com/releases/2023/10/231023124342.htm>.

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