Do biological drugs work better alone or in combination with other drugs for patients with advanced non-small cell lung cancer who previously received treatment?

This study compared if anti-PD-1 biological drugs were more effective alone or when used with other drugs to treat patients with advanced non-small cell lung cancer who had previously received treatment. The results showed that the combination of anti-PD-1 and other drugs such as chemotherapy improved patients’ survival more than anti-PD-1 drugs alone.

There are many treatments available for patients with advanced non-small cell lung cancer (NSCLC).  Often patients begin treatment (first-line) with chemotherapy or inhibitor drugs. This is not effective for some patients. These patients are given other drugs as second-line therapy. 

Anti-PD-1 biological drugs, such as pembrolizumab (Keytruda) and nivolumab (Opdivo), have improved treatment results. The combination of anti-PD-1 drugs with other treatments such as chemotherapy or inhibitor drugs has improved results for patients when used as first-line treatments. However, it is unclear if anti-PD-1 drugs are more effective in a combination or alone for patients with advanced NSCLC who have previously received treatment.

The records of 55 patients with advanced NSCLC who had previously received treatment were analyzed. They were divided into two groups. The first group received anti-PD-1 treatment in combination with other drugs as a second-line treatment (22 patients). The second group received anti-PD-1 treatment alone as a second-line treatment (33 patients).

Patients had a 72% chance of longer survival without cancer worsening with the combination treatment. Patients who received combination treatment survived for an average of 7.5 months without the cancer worsening. Patients who received anti-PD-1 drugs alone survived for an average of 3.3 months without the cancer worsening.  

31.8% of patients had a response to combination treatment, compared to 10% who received anti-PD-1 alone. Within the combination group, 40% of patients responded to anti-PD-1 and chemotherapy. 0% of patients responded to anti-PD-1 and bevacizumab (Avastin). 75% responded to anti-PD-1 and chemotherapy and bevacizumab.

63.6% of patients in the combination group and 30% of patients in the anti-PD-1 alone group had at least one tumor shrink from treatment.

95.5% of the combination group and 87.9% of the anti-PD-1 alone group developed side effects. The most common side effects were nausea and fatigue.

The authors concluded that the combination of anti-PD-1 with chemotherapy and/or bevacizumab improved second-line treatment outcomes for patients with advanced NSCLC.

This study was limited by its retrospective analysis, meaning that not all information was available for patients. The small size of this study means that results may not reflect a larger group.