Posted on 06/05/2023 7:52:31 AM PDT by ConservativeMind
Over the past decade, the approval of immune checkpoint inhibitors has revolutionized treatment for patients with advanced lung cancer, helping many live longer lives and improving overall survival for the disease. However, an important question has remained unanswered: How long should a patient with advanced non-small cell lung cancer (NSCLC), who receives immunotherapy as part of their initial treatment, continue with treatment?
A new retrospective cohort study suggests that it's reasonable to stop immunotherapy treatment at two years as long as their cancer hasn't progressed.
The researchers found no statistically significant difference in overall survival between patients who stopped treatment at two years and those who continued treatment indefinitely.
"We hope this data provides reassurance that stopping treatment at two years is a valid treatment strategy that does not seem to compromise overall survival," said Lova Sun, MD.
The appropriate length of treatment remains an open question because pivotal clinical trials have used different treatment durations, and as therapies have been approved and become widely available, many patients have continued therapy beyond the one to two years tested in clinical trials. The longer a patient continues treatment, the higher the costs and risk of immune-related side effects.
In this study, the researchers analyzed de-identified data from a national electronic health record that included patients with advanced NSCLC who were treated in both academic and community settings. Of the 1,091 patients who received an immune checkpoint inhibitor as part of their initial therapy (either alone or in combination with chemotherapy) and whose cancer had not continued to grow, only one in five stopped immunotherapy at two years and were considered the "fixed duration" group for this analysis.
The team analyzed the data and found similar overall survival probabilities between the two groups: 79% for fixed duration and 81% for indefinite duration.
(Excerpt) Read more at medicalxpress.com ...
I noticed that nowhere in the article do they give an actual life expectancy expressed in number of years.
My wife has been getting immunotherapy for a cancer in her lungs for 3 and 1/2 years now. The doctor told her the clinical trials only went for 2 years. She is in Uncharted Territory, but he said that he will give her the immunotherapy indefinitely as long as it is helping her.
The main concern in the article appears to be the increased cost to the Healthcare System. My main concern is my wife’s increased lifespan.
More of reasoning for limiting medical care for folks that aren’t expected to be around much longer? Maybe we are heding to Canada’s “If your sick, suicide is just another form of medical care”.
In both sets of people in the study, the cancer was shown to be stopped.
There is nothing wrong with restarting therapy if a future test or scan shows a change.
Grade 3 or worse issues definitely happened a lot more with unlimited antibody use.
“...both sets of people in the study, the cancer was shown to be stopped...”
Stopped for how long? Wife’s Dr indicated if she stopped immunotherapy her cancer could regrow to its former size within a year. He had no history as to whether restarting immunotherapy afterwards would work a second time.
That’s not a risk we’re willing to take.
As a cancer survivor and as someone who works in the pharmaceutical industry, I understand your concern. Immunotherapies work so differently than traditional chemotherapy however, so I think how long to keep someone on an immunotherapy drug is a reasonable question. I think as long as there's an opportunity to return for follow-up treatments should the cancer reappear, it would be OK to end current treatments. That's just my opinion as an outsider though, and I'm NOT a medical doctor.
To your point about your wife's clinical trial, it's not an uncommon scenario at all. When planning clinical trials, you must have some kind of end of trial date in mind. With oncology trials however, it would be unethical to pull someone off a trial where the drug was having a positive effect on a patient. I've seen patients receiving oncology drugs even 4 -5 years after the end of the trial (which means the pharma company has to continue to make and provide that drug, even if the drug was never approved or pursued into commercialization.)
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