Introduction
Every year, there will be a certain treatment that will be the highlight of discussion and presentations in every oncology meetings/ events.
Last year, it was immunotherapy durvalumab, which delivered superior results for stage 3 non-small cell lung cancer (NSCLC);
- adenocarcinoma and squamous
- irrespective of EGFR status (wild type or mutant)
- irrespective of PD-L1 status (no PD-L1 testing required)
Addition of durvalumab after concurrent chemo-radiotherapy treatment as adjuvant in stage 3 NSCLC prevent cancer from progressing for longer time.
Suitable patients must be:
- Stage 3 lung cancer
- Histology: non-small cell lung cancer (NSCLC) – adenocarcinoma, squamous
- Good performance status a.k.a able to walk about and perform daily activities independently
- Complete concurrent chemotherapy and radiotherapy treatments
Results?
- On average, 3x longer duration without disease progression 16.8 months (trimodality) vs 5.6 months (chemotherapy and radiotherapy only).
- At 18 months, no progression of cancer in 44% of patients on trimodality (vs 27% patients on chemotherapy and radiotherapy only).
Important: This medication, which will likely cost above 100k, is currently available for free as it is awaiting registration and approval from regulatory authority.
[Programme ended. Treatment now cost around 150k for one year treatment; two weekly treatment x 26, with patient assistance program buy 1, free 1.]
The above result was undeniably good and the final result on overall survival will likely show improvement as well.
I hope more stage 3 patients will be able to have access to this effective treatment.
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Update (post ESMO Munich 2018);
Further analysis of Pacific trial data noted that this treatment was:
- Less effective/ no significant treatment with placebo in NSCLC patients with:
- PD-L1 mutation < 1%
- EGFR mutation positive
- More effective in NSCLC patients
- Using cisplatin and etoposide concurrent chemotherapy
- Initiating durvalumab treatment less than 14 days (when compared with > 14 days) after completion on concurrent chemo-radiotherapy.
