Immunotherapy: a game-changer for lung cancer

Since September 2017, Prof. Nicolas Girard has headed up the Curie-Montsouris Chest Center. The Center’s aims are twofold:

• To provide innovative course of treatment for all patients suffering from lung cancer
• To deploy research, ranging from clinical to basic, in the fight against lung cancer.

The field is certainly not short of new discoveries. “Without a doubt, immunotherapy seems to be the most promising treatment. And it would appear that it is effective during different stages of cancer: localized, advanced, and metastatic. Institut Curie is involved in several trials designed to confirm what this therapeutic strategy has to offer, as well as to better identify the patients that could benefit from it,” the oncologist and pulmonologist explains.

Advances at all stages of the disease

Some of the most exciting innovations presented during the AACR annual meeting (held on April 14¬18, 2018) included new revelations about the potential of immunotherapy. Administered prior to surgery, i.e. as a neoadjuvant, immunotherapy—in this case nivolumab—led to the disappearance of almost all cancer cells in almost half of patients.

Another highly promising result for patients with advanced lung cancer involved the combination of immunotherapy with classic chemotherapy: after one year, 70% of 600 patients were still alive and their disease had stopped progressing. “Currently, with chemotherapy alone, the chances of survival are just 50% one year after diagnosis. So these are very encouraging results!” exclaims Prof. Girard. “But further studies are needed to back up these data and identify which patients will respond best to the different immunotherapies.” To improve patient quality of life, a trial is underway involving longer time periods between the administration of immunotherapy: one month compared to the current period of two weeks.

For more advanced forms, another trial currently being conducted at Institut Curie is attempting to determine the appropriate combinations and administration times for newly available immunotherapies. The Cancer Immunotherapy Center is playing a significant role in this work.

Immunotherapy appears to be able to restore the immune system’s ability to fight cancer cells. It may continue to work after it has been administered, potentiating the effects of another treatment. The trial therefore involves studying in real time the tolerance of and response to different combinations of chemotherapy and immunotherapy in patients with advanced non-small cell lung cancer.

In terms of immunotherapy administered prior to surgery, Institut Curie is currently conducting a trial in patients with non-small-cell cancer that is not very advanced. “The aim of neoadjuvant administration is primarily to reduce the size of the tumor to make the surgical procedure easier, or to enable us to offer surgery to patients in whom removal of the tumor was not initially possible,” the professor explains. “But there is another benefit that appears to be emerging and that needs to be studied: a reduced risk of relapse.” Immunotherapy appears to be more effective than chemotherapy at destroying the remaining tumor cells, which is why clinical trials are needed to confirm this benefit. Collaboration with Institut Mutualiste Montsouris and its surgical and pulmonology teams is crucial to ensuring that patients receive the best possible course of treatment; coordination is absolutely essential at every stage of patient care.

Rare thoracic cancers have not been forgotten: several trials are being launched to evaluate the potential benefits of immunotherapy on thymus cancer and neuroendocrine tumors. As part of the EURACAN reference network for rare cancer treatment, Prof. Girard is coordinating a collaborative project involving up to 20 hospitals specialized in the treatment of these tumors, providing a new opportunity for these patients, who are often excluded from therapeutic trials.

Immunotherapy offers great hope, but there is still much to decipher. “We must continue analyzing the immune system in real time: its reactions and specific characteristics in patients with tumors ranging from early-stage to metastatic. This is a vital step in the transition to a new generation of immunotherapy, personalized according to each tumor and, above all, to each patient. Other avenues are also being explored, in particular the possibilities of combining these antibodies with other immunomodulators to achieve more effective therapy,” Prof. Girard concludes.

Immunotherapy offers hope

Prior to surgery, for localized or only mildly advanced forms:

• To reduce the size of the tumor and make it easier to remove in its entirety
• To offer surgery to patients in whom removal of the tumor was not initially possible
• To reduce the risk of relapse. 

After surgery, for advanced forms:

• To destroy tumor cells locally and at a distance
• To extend the treatment response.

For metastatic forms:

• To halt disease progression
• To potentiate the effects of chemotherapy.