Lung cancer is the leading cause of cancer-related mortality worldwide. For patients with early-stage (stages I and II) non-small cell lung cancer (NSCLC) and, in some appropriate cases, locally advanced (stage IIIA) NSCLC, complete surgical resection of the tumor lesion is the best treatment. Despite the advances in early diagnosis and treatment of lung cancer in the last two years, which have effectively improved survival, the worst part is that postoperative recurrence eventually leads to death.
According to statistics, recurrence occurs in 30%-75% of lung cancer patients after surgical resection, including about 15% of stage I lung cancer patients. Most recurrent tumors occur in distant lesions, and more than 80% of recurrent lung cancers occur within the first two years after resection. Therefore, even early stage patients live with the constant fear and anxiety that their cancer will recur. Once recurrence and metastasis occur, they are at risk. Recurrence is an important reason why many lung cancer patients fail in their fight against cancer, and how to avoid recurrence after surgery is one of the most important concerns of every patient and family.
A 24% reduction in the risk of recurrence or death! Early stage lung cancer patients have a "reassurance" therapy!
Recently, Merck's monoclonal antibody therapy Keytruda released the latest clinical data showing that Keytruda reduced the risk of early lung cancer recurrence or death by 24% in patients who underwent surgery!
In a phase 3 trial, code-named KEYNOTE-091, more than 1,000 patients with post-surgical early-stage lung cancer (stage IB (≥4 cm) to stage IIIA, regardless of PD-L1 expression) were evaluated. These patients were randomized into two groups, with 590 receiving Keytruda and 587 receiving placebo.
The results showed that adjuvant treatment with pembrolumab significantly improved disease-free survival (DFS) compared to placebo, while reducing the risk of disease recurrence or death by 24%.
The median disease-free survival (DFS) for pembrolumab was 53.6 months, more than 4 years, compared to 42.0 months for placebo, an extension of almost a year!
This means that patients with early-stage lung cancer can live at least another year or more with post-operative adjuvant therapy with Pymab!
Before the advent of immunotherapy, lung cancer had a five-year survival rate of only 5% once recurrence and metastasis occurred! Now, Keytruda in combination with chemotherapy has been able to increase the five-year survival rate to 40%, a full eight-fold increase! And now we can reduce the risk of recurrence and metastasis again and extend the survival period again, which is a great progress in medicine, and the hope of turning lung cancer into a chronic disease will become a reality!
We look forward to the early release of this treatment, so that more early stage patients can escape the curse of recurrence and truly achieve a "cure"!
How to prevent recurrence in early stage lung cancer patients?
In addition to the exciting new research above, there is now a proliferation of post-operative adjuvant therapies that have enabled more and more patients with early-stage lung cancer to achieve longer survival. Global Oncologist Network Medical has summarized several ways to prevent recurrence of early stage lung cancer for patients.
FDA-approved post-operative recurrence prevention therapy for lung cancer - Tecentriq
On October 16, 2021, the FDA approved atezolizumab (Tecentriq) for the adjuvant treatment of patients with stage II to IIIA non-small cell lung cancer (PD-L1 ≥ 1%) after resection and platinum-based adjuvant chemotherapy.
It is noteworthy that this is the first and currently the only adjuvant immunotherapy approved worldwide for lung cancer patients after early surgery.
The results showed that Tecentriq significantly prolonged the survival of patients with early-stage lung cancer, with more than 60% of patients surviving disease-free for 3 years. The best supportive care regimen had a disease-free survival (DFS) of 35.3 months, while Tecentriq did not achieve a median DFS.
In addition, it was able to reduce the patient's risk of disease recurrence or death by 34% compared to the best supportive care program.
Immunomodulation and Reconstruction
The immune function of lung cancer patients is in a state of malfunction, and surgery, radiotherapy and chemotherapy will cause certain damage to the immune function of human body. After clinical treatment, adjusting the immune function as soon as possible is the most important thing to prevent recurrence and metastasis.
For patients with low or abnormal immune function, clinicians may recommend injections of thymic peptides, interferon, cellular immune return for restoring immune test function and restoring immune killing function, etc.
Relay Cellular Therapy is a technology that collects the body's own immune cells, cultures them in vitro, multiplies their number thousands of times, increases their targeted killing function, and then transfuses them back into the patient's body to kill pathogens, cancer cells, and mutated cells in the blood and tissues. Clinical adjuvant therapy with immune cells such as NK, DC, and T cells has been studied in numerous clinical studies. Patients who want to know the latest research progress can call the medical department of Global Oncologist Network
One of the important members of immune cells - NK cells. In medicine, NK cells play a key role in the first line of defense against cancer; NK cells have two aspects of anticancer action: first, they have the aforementioned direct killing of tumor cells by releasing post-perforin and granzyme or by death receptors; second, they play the role of regulatory cells of the immune system by secreting cytokines and chemokines, activating the killing action of T cells and others. These features enable NK cells to be promising in tumor immunotherapy, and numerous clinical studies are being conducted both nationally and internationally.
The good news is that in May 2020, a domestic study of NK cells combined with PD-1 published in The Journal of Clinical Investigation, a top international journal, attracted widespread attention. The study ultimately recruited 109 patients with PD-L1 high expression non-small cell lung cancer and randomized them into group A (55 patients) receiving NK cells in combination with PD-1 (pacrolimus) and group B (54 patients) receiving pacrolimus only. The results showed that the objective remission rate (ORR) in group A was 36.5%, which was significantly better than that in group B, which was 18.5%. This indicated that the therapeutic effect of pembrolizumab combined with NK cell therapy was nearly one times that of treatment with pembrolizumab alone. In addition, the overall survival and progression-free survival were significantly longer in group A.
Dendritic cells are the most functional antigen-presenting cells known in the body, and are best characterized by their ability to stimulate initial T cells to proliferate. Therefore, DCs are the initiators of the body's immune response and have a unique position in the induction of the immune response. Dendritic cells fully activate T cells in vivo and promote T cell clearance of tumors. Dendritic cells also promote T cell enrichment and enhance activation of T cells.
Excellent clinical data are now available for dendritic cell vaccines in lung cancer.
Lung cancer dendritic vaccine DCVAC/LuCa
DCVAC/LuCa is a dendritic cell vaccine for patients with non-small cell lung cancer developed by a US-based biological company called SOTIO. By fusing dendritic cells with antigenic material released from the patient's own lung cancer cells after lysis and death, the dendritic cells gain the ability to recognize lung cancer cells and are amplified in vitro and fed back into the patient for treatment. This U.S. prospective therapy is currently in a phase II clinical study at Shanghai Chest Hospital, a leading cancer center in China.
Just recently published data confirm that this therapy has shown synergistic effects and significant potential in improving patient survival. Dramatic improvement in overall remission rates! First-line treatment of advanced non-small cell lung cancer with dendritic cell vaccine in combination with chemotherapy is showing early signs of success
Cytotoxic T cells (Tc or CTL), also known as killer T cells, are cells that monitor and, when needed, kill target cells. Cytotoxic T cells have a memory function for antigen-bearing target cells, and once a target cell with a specific antigen is identified, it stimulates effector cytotoxic T cells to produce effector cytotoxic T cells to destroy the infected cells or cancer cells. T-cell based CAR-T therapies have been approved in China, the US and Japan, and TILs therapies and TCR-T therapies are undergoing extensive clinical studies. In addition, there are multi-targeted compound antigen T cells currently undergoing clinical research as immunomodulatory tools. Domestic tumor cell immunotherapy is emerging - the new generation of MTCA-CTL technology is introduced!
Nutritional support therapy
Nutritional therapy and its role in cancer rehabilitation is also in a very important position: according to the World Health Organization survey statistics, about 35% of cancer patients are related to unscientific and unbalanced diet. Professor Doyle, an international authority on tumor epidemiology and a famous British oncologist, also pointed out that a reasonable diet can reduce the mortality rate of stomach and colon cancer by 90%, endometrial cancer, gallbladder cancer, pancreatic cancer and esophageal cancer by 20%, and can reduce the total mortality rate of cancer by 10%.
In daily life, people also want to know what to eat to improve immunity, is it more ginseng, wormwood, sea cucumber can improve immunity? There is no answer to this question, doctors either can't answer it or tell you every time that you should have a balanced diet and balanced nutrition. In fact, it is true that a balanced diet is the basis to ensure that all body functions are normal, especially to maintain immunity.
The overall principles are.
First, eat more plant-based foods.
Second, choose a low-fat diet.
Third, intake of lean protein.
Finally, limit the intake of the three major carcinogens: sugar, alcohol, and processed meat.
For example, in the early stage of lung cancer, all kinds of nutrition should be supplemented in time so that the body can tolerate the future treatment, and more protein and other high-energy substances, vitamins and minerals can be added; when lung cancer is treated with radiotherapy or chemotherapy, food to supplement qi and blood should be given, such as cilantro carp soup, bird's nest, shiitake mushroom and wood ear.
Stay away from relapse and open the door to long survival
In addition to close clinical monitoring and intervention using advanced medical technology to boost immunity, another important point is an optimistic and positive mindset in fighting cancer.
As a cancer patient said in his own experience, "In the face of cancer, whoever can build up the belief of winning, follow the scientific principles of prevention and treatment, work closely with the treating doctors, try to adapt to the new environment, develop interests and hobbies in the surrounding things, and resolutely fight against the disease, will have the hope of survival and recovery".
Indeed, we can also see clinically that under the same medical conditions, some patients who are cheerful-minded and have a strong will to fight against the disease have much better treatment results than those who are thinking ahead and in extreme mental distress because of cancer. If the spirit is completely destroyed, even the best treatment will not yield the desired results.
Last but not least, I hope all the patients can strengthen their confidence and determination to fight against cancer and open the door of long survival for themselves!