Additonal immunotherapy before surgery improves treatment success in lung cancer

A current lung cancer study shows: patients benefit from being treated with the antibody durvalumab before and after surgery. This result was published by Martin Reck from the LungenClinic Grosshansdorf together with a team of international scientists in the New England Journal of Medicine.

Immunotherapies have revolutionised the treatment of lung cancer in recent years. However, science does not stand still, but tries to further improve diagnostics and therapy. If a tumour is operable, surgery is generally followed by a so-called adjuvant therapy*: This can be, for example, immunotherapy, chemotherapy or radiotherapy, or a combination of these. What effect does it have, if patients also receive immunotherapy before surgery (neoadjuvant therapy**)?

AEGEAN trial uses antibodies against PD-L1

This question was answered by researchers in the AEGEAN study for non-small cell lung cancer (NSCLC). They treated patients with the immunotherapeutic antibody durvalumab in combination with chemotherapy before they underwent surgery. Durvalumab recognises the protein PD-L1 and interferes with its interaction with PD-1, thereby enabling the immune system to better recognise and attack the tumour. (Details on this principle can be found here.) The study procedure is shown in the adjacent figure: All patients received chemotherapy before their operation. In addition, people in the therapy group (1) received durvalumab before and after surgery, while people in a control group (2) received a placebo instead.

The results were clear: On average, those treated with durvalumab lived longer without a recurrence. In this group, four times more often no living tumour cells were detectable in the surgical specimen. In addition, it is assumed that the neoadjuvant treatment with durvalumab destroys smaller metastases in the body – and it does this better than the chemotherapeutic drug alone. The side effects were comparable to those of the single agents.

Final evaluation of the study and consideration in the guidelines is pending

Even if the survival time cannot yet be conclusively assessed, Prof. Dr. Martin Reck already observes significant results: “We found a relevant clinical effect of this perioperative immunotherapy*. In addition, we saw significantly more complete pathological remissions: this means that our pathologists didn’t find any living cells at all in the removed tumours.” The medical guidelines already recommend some neoadjuvant/perioperative immunotherapies (with or without additional chemotherapy). Martin Reck expects further approvals in the spring of 2024.

Martin Reck is a physician at the LungenClinic Grosshansdorf, Principal Investigator at the Airway Research Center North (ARCN) and at the German Center for Lung Research (DZL). The AEGEAN study, on which the publication in the New England Journal of Medicine is based, was sponsored by AstraZeneca.

 

*adjuvant therapy: additional therapy (e.g. chemo-immune or radiotherapy) following surgery.

**neoadjuvant therapy: intended to reduce the tumour mass before surgery

***perioperative therapy: treatment before and after surgery

 

Source and publication: Heymach JV, Harpole D, Mitsudomi T, Taube JM, Galffy G, Hochmair M, Winder T, Zukov R, Garbaos G, Gao S, Kuroda H, Ostoros G, Tran TV, You J, Lee K-Y, Antonuzzo L, Papai-Szekely Z, Akamatsu H, Biswas B, Spira A, Crawford J, Le HT, Aperghis M, Doherty GJ, Mann H, Fouad TM, Reck M (2023) Perioperative Durvalumab for Resectable Non–Small-Cell Lung Cancer. New England Journal of Medicine (ARCN) Link to the article

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