Combination Therapy for lung cancer treatment is one of the latest, most exciting advances in lung cancer research. Studies of patients being treated with combination therapy show increase in the overall survival rate for lung cancer patients. Combination therapy refers to the use of more than one medication at a time to treat lung cancer. It is currently used for both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).
In the 1970s, researchers discovered that using a combination of drugs to treat a cancer patient increases the chance that all of the cancer cells will be eliminated. Preliminarily, clinical trials have shown that the combination of immunotherapy with other therapy, such as chemotherapy, radiotherapy, and targeted therapy, achieve greater therapeutic effects for treating small cell lung cancer (SCLC).
Some of the positive reasons doctors may choose to recommend combination therapy for certain lung cancer patients are:
- A single treatment might not be sufficient to make the tumor shrink
- Sometimes adding an additional treatment may make the original treatment work better
- Certain treatments might be more effective at different stages of your treatment journey.
Chemotherapy with Immunotherapy
Chemotherapy drugs affect cancer cells at different points in the cell cycle. Sometimes chemotherapy is used along with immunotherapy. The benefits seen are:
- decreased resistance
- earlier administration of medications
- multiple targeted attacks
- drugs work better together
- lower doses can be used
Cancer cells have a way of hiding from the patient’s immune system. Immunotherapy drugs work by helping the immune system recognize and attack cancer cells. Lung cancer cells are broken down by chemotherapy drugs. This action makes the immunotherapy drugs more effective at identifying these lung cancer cells as abnormal.
Combination chemotherapy is effective and can:
- work to extend life
- reduce the risk of cancer recurrence
- improve the results from immunotherapy.
Combination Therapy for SCLC Shows Longer Overall Survival
A recent study of adults with extensive stage small-cell lung cancer showed that the immunotherapy Imfinzi, in combination with a choice of chemotherapies, etoposide plus either carboplatin or cisplatin, showed an overall survival benefit of three years.
Possible Risks of Multiple Medications for SCLC
Of course, adding more medications to a treatment plan can augment negative reactions. The risk of adding more medications can increase the side effects. It is also possible to have unwanted interactions with medications, and, it may be difficult to determine which treatment is responsible for the negative side effect.
Combination Therapy for NSCLC Treatment
Recent clinical trials of patients with advanced non-small cell lung cancer showed that combinations of immunotherapy with chemotherapy are a very effective first line treatment.Combining pembrolizumab with conventional chemotherapy in the first-line setting significantly prolongs median overall survival in patients with metastatic squamous non–small cell lung cancer (NSCLC). For some people with advanced NSCLC, a targeted therapy drug or an immunotherapy drug may be given along with chemotherapy.
Combining immunotherapy with targeted radiation resulted in a greater response rate than immunotherapy alone in a phase 2 clinical trial in patients with early-stage, non-small-cell lung cancer. Recent clinical trials have suggested that combining an immunotherapy with traditional chemotherapy may be even more effective than immune-targeting drugs alone, as a pre-surgery treatment.
The initial treatment for stage IIIA NSCLC may include some combination of radiation therapy, chemotherapy (chemo), and/or surgery.
Combination EGFR Therapy Boosts Survival in Early Lung Cancer
Adding rivoceranib (aka apatinib) to Iressa helped keep cancer at bay in previously untreated, EGFR-mutated non–small cell lung cancer (NSCLC) patients. Apatinib works as a tyrosine kinase inhibitor (TKI) that selectively inhibits VEGFR2, while Iressa works as an epidermal growth factor receptor (EGFR) inhibitor, which interrupts signaling through the EGFR in target cells.
Immunotherapy + Chemo Boosts Response in Resectable NSCLC
Neoadjuvant chemotherapy with nivolumab plus platinum-doublet chemotherapy significantly improved response rates compared with chemotherapy alone in patients with resectable stage IB to IIIA non–small cell lung cancer (NSCLC)
Using Both Immunotherapy and Chemotherapy Doubles Lung Cancer Survival
Lung cancer experts have been impressed by long-term study results that continue to show the combination of immunotherapy and chemotherapy doubles survival compared with chemotherapy alone. The results are from a 4-year follow-up of patients with previously untreated stage IV non-small cell lung cancer (NSCLC) taking part in the trial of immunotherapy drug pembrozlizumab (Keytruda) plus pemetrexed–platinum chemotherapy. Previous results from the study had already demonstrated that, after a median follow-up of 10.5 months, adding pembrolizumab to chemotherapy significantly improves both overall survival and progression-free survival compared with chemotherapy alone.
A Promising New Treatment Frontier
Clinical trials continue for both SCLC and NSCLC evaluating which combination therapies are most effective for which patients. With the promising results seen so far, it is clear that combination therapy for lung cancer treatment shows great promise for lung cancer patients.
FDA-Approved Treatments for Combination Therapy
“We’re quite hopeful that we can build on the initial progress that’s been made with the introduction of immunotherapy for this disease. I think that gives us a proof of principle that the immune system can react in a positive way to this disease. I also think there are a number of ideas about how to augment that immunotherapy response to make this cold tumor hot—to inflame this tumor and augment the efficacy of immunotherapy. Actually, I think that may be the most promising avenue of research looking forward 5 or 10 years in the future for small cell lung cancer.”
– Dr. Charles Rudin, Memorial Sloan Kettering Cancer Center