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Immunotherapy before and after surgery improved lung cancer outcomes

Image credit – National Cancer Institute

CANCER DIGEST -- Oct. 27, 2023 -- Lung cancer patients who underwent immunotherapy before and after surgery had a 32 percent lower risk of recurrence compared to patients who underwent chemotherapy alone before surgery, results of a new study show. The findings of the large phase 3 clinical trial were published in the Oct. 23, 2023 issue of the New England Journal of Medicine.

The AEGEAN trial evaluated the effectiveness of using chemotherapy and the immunotherapy drug durvalumab before surgery and durvalumab after surgery in comparison to patients receiving current standard of chemotherapy only before surgery.

“Our goal is to increase cures for lung cancer. Throughout decades of research with adjuvant and neoadjuvant chemotherapy, we only succeeded in increasing cures by around 5 percent,” principal investigator John Heymach, M.D., Ph.D., said in a press release. He is chair of Thoracic/Head & Neck Medical Oncology at MD Anderson and lead author of the study. “This one study alone has the potential to increase that percentage significantly, and we look forward to many more improvements going forward.”

At the time this study was published, the ongoing phase 3 AEGEAN trial enrolled 802 adults with a median age of 65 with untreated stage IIA-IIIB non-small cell lung cancer. Patients were randomly assigned into each treatment arm. The study's primary endpoints are pathologic clinical response, assessed by a central lab, and event-free survival using a blinded independent central review.

Of the 740 evaluable participants, 366 were randomly assigned to receive the regimen with durvalumab and chemotherapy before surgery and durvalumab after surgery. There were 374 assigned to receive standard therapy with chemotherapy alone before surgery.

Of the durvalumab group 17.3 percent had pathologic complete response, meaning no evidence of cancer in tissue samples examined by a pathologist. That compared to 4.3 percent of those who received chemotherapy alone. After a median follow-up of 11.7 months event-free survival had not been reached in the durvalumab group, and had reached 25.9 months in the chemo-alone group.

When the researchers compared these data to historical data it corresponded to a 32 percent lower chance of patients experiencing cancer recurrence, progression, or death with the immunotherapy-based treatment compared to chemotherapy alone.

Patients experienced side effects in similar numbers with 42.4 percent of the durvalumab group experiencing side effects compared to 43.2 percent of the chemotherapy group.

The study was funded by AztraZeneca.

Sources: MD Anderson Cancer Center press release and the New England Journal of Medicine


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