Patients with non-small cell lung cancer will have new therapeutic alternatives to first-line chemotherapy.

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Two studies have shown the efficacy of alternatives to first-line chemotherapy for some subgroups of patients with advanced non-small cell lung cancer (NSCLC). This has been announced within the framework of the ESMO 2019 Congress, which will be held in Barcelona until next October 1.

These are the FLAURA and CHECKMATE 227 trials. The first of these focuses on patients with advanced NSCLC with an EGFR mutation (acronym for epidermal growth factor receptor) who had not previously received treatment. In it, treatment with osimertinib was associated with a significant improvement in overall survival compared to the comparison treatment. The median survival was 38.6 months in the osimertinib arm, and 31.8 months in the control group. The 36-month survival rate was 54 percent and 44 percent for each of the arms, respectively. The safety data are similar to those published in previous studies.

In the words of Pilar Garrido, head of the Thoracic Tumor Unit of the Ramón y Cajal University Hospital in Madrid, “the FLAURA study shows that the use of a new-generation oral medication not only slows the progression of the disease, including the brain, but it improves survival without increasing toxicity. ” However, it has also clarified that patients with the characteristics of the population studied in this trial represent only 10-15 percent of those affected by lung tumors.

The immunotherapy combination

On the other hand, the CHECKMATE 227 study is a phase III study in which 1,189 patients with stage IV non-small cell lung cancer or relapse were recruited. In part 1 of the trial, patients with PD-L1 expression of at least 1 percent were randomized into three treatment options: nivolumab plus ipilimumab at low doses; Nivolumab alone or chemotherapy. Patients with PD-L1 less than 1 percent received nivolumab plus ipilimumab at low doses, nivolumab plus chemotherapy or only chemotherapy.

In conclusion, overall survival was significantly higher with the combination of immunotherapy against chemotherapy in all subgroups. Likewise, the combination safety profile was consistent with previous findings in patients with advanced non-small cell lung cancer. Therefore, the trial authors conclude that the combination of nivolumab + ipilimumab represents a new treatment option for these patients.


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