Is targeted therapy better at treating advanced NSCLC than current chemotherapy treatment?

This study examined the effectiveness of the targeted therapy drug nivolumab (Opdivo) at treating advanced non-small-cell lung cancer, particularly for patients with cancer that has spread to the liver. The authors concluded that nivolumab led to an improved overall survival compared to chemotherapy for these patients.

Current cancer therapy heavily relies on chemotherapy. As technology advances however, therapies are available to target specific types of cancers. Many tumor cells have a protein (PD-L1) which stops the immune system from killing them. New therapies that block PD-L1 allow the immune system to kill the cancer cells. Anti-PD-L1 therapies include the drug nivolumab (Opdivo), which has shown better activity than chemotherapy in some cancers.

For patients with advanced non-small-cell lung cancer (NSCLC) that has spread to the liver, prognosis is poor. It may be that targeted therapy might be better than chemotherapy for advanced NSCLC that has spread to the liver.

This study aimed to determine the effectiveness and safety of nivolumab in patients with NSCLC and specifically where cancer has spread to the liver.

854 patients with squamous or non-squamous NSCLC were included in the study. 427 patients in group A were treated with nivolumab while 427 patients in group B were treated with the chemotherapy drug docetaxel (Taxotere). Of these 854 patients, 193 had cancer that had spread to the liver. Patients were followed for at least 40.3 months.

From the overall population, the chances of longer overall survival (OS, time from beginning trial until death) was 30% higher for patients in group A compared to group B. At 3 years after treatment, the OS rate was 17% for group A patients and 8% for group B patients. 3 year progression free survival (PFS, time from treatment until disease progression) for group A patients was 10% and less than 1% for group B patients.

For patients with cancer that had spread to the liver, the chance of longer OS was 32% higher for group A patients than group B patients. The 3 year OS rate was 8% for group A patients and 2% for group B patients.

Nivolumab caused a 4% higher number of hepatic (liver related) side effects in patients with liver cancer compared to the overall population.

The authors concluded that nivolumab showed an improved OS compared to chemotherapy for patients with advanced NSCLC and those with cancer that had spread to the liver.

This study was funded by the manufacturers of nivolumab.