A ‘Miraculous Class of Drugs’ to Increase Accessibility in Lung Cancer

Tislelizumab plus chemotherapy demonstrated clinically meaningful improvements in progression-free survival (the amount of time that a patient lives with cancer without disease worsening after treatment) versus standard of care chemotherapy as a first-line treatment for patients with stage 3B or 4 advanced squamous non-small cell lung cancer (NSCLC).

Of note, tislelizumab is not approved by the Food and Drug Administration, but there are ongoing trials looking into this monoclonal antibody checkpoint inhibitor.

According to Dr. Jorge J. Nieva, a medical oncologist and section head of solid tumors at USC Norris Comprehensive Cancer Center in Los Angeles, while the data presented don’t necessarily show anything new, these results foreshadow innovations like lower drug prices, which will benefit patients with lung cancer worldwide who may not have been able to afford the treatment otherwise.

“The development of these Chinese drugs is going to drive two things. It’s going to drive lower prices and it’s going to drive innovation,” he explained in an interview with CURE®. “It’s going to be easier for these Chinese firms to replicate Western clinical trial results with new antibodies. From my standpoint, these antibodies are all more alike than they are different. While many of us prefer to drink Coca-Cola or Pepsi, generic colas taste pretty similar. That’s effectively what we have here. This is going to require the drug manufacturers in the U.S. and Europe to begin to develop more innovation. ... These changes are all good for patients.”

In the study, patients received one of the following combinations:

• A treatment regimen of tislelizumab plus paclitaxel (group A).
• Tislelizumab plus Abraxane (nab-paclitaxel) and carboplatin (group B).
• Standard-of-care chemotherapy with paclitaxel plus carboplatin (group C).

Findings showed that progression- free survival was longer in the groups that received tislelizumab. Specifically, for those with stage 3B disease, the median progression-free survival for group A was 9.8 months versus 5.6 months in group C. The median progression-free survival in group B was 11 months.

For patients with stage 4 disease, the median progression-free survival in group A was 7.6 months versus 5.2 months in group C; the median progression-free survival was 7.4 months in group B.

In terms of overall response rate (the number of patients who see a partial or complete response to therapy), patients with stage 3B disease demonstrated an overall response rate of 84.2%, compared with 82.5% in group B and 59.1% in group C. For patients with stage 4 disease, group A showed an overall response rate of 67.1%, compared with 70.9% in group B and 44.2% in group C.

Nieva said the outcomes associated with tislelizumab are similar to those of a common checkpoint inhibitor.

“This is generic Keytruda, and (patients) don’t need to think about it as anything more than that,” he said. “It’s a similar strategy in terms of drug selection (and) effect size. It’s another study of chemotherapy in combination with a PD-1 checkpoint inhibitor. It shows that adding a checkpoint inhibitor to chemotherapy makes it work better, so there’s nothing new to learn here. ... All we learned is that it doesn’t matter who manufactures the antibody; you’ll get a similar effect. And so to that sense, the only thing the study told us is that maybe someday prices will come down.”

The most common side effects across all groups included anemia, hair loss, decreased white blood cell count and low neutrophil count.

“There (are) a lot for patients who have high PD-L1 scores. They can be treated with a checkpoint inhibitor alone, ... with a checkpoint inhibitor plus chemotherapy (or) ... two checkpoint inhibitors and chemotherapy. All of these are options. And they all represent overwhelming advance over how we treated lung cancer patients 10 years ago that no matter which particular strategy is selected by a patient and their doctor, they know that anything that involves these — I could say almost miraculous class of drugs — is going to be giving them an opportunity for cure,” Nieva said.

He also added that he hopes that studies like this will push researchers in the U.S. to discover more innovative treatments, including subcutaneous formulations (drugs given as an injection) instead of intravenous ones (drugs given through the veins). He also said that this could lead to newer checkpoint inhibitors that may generate similar responses.

“There are a number of exciting new checkpoints that are going to come out and understanding how to use those checkpoints in an additive fashion with the current standards of care is going to be important,” Nieva said. “We’re going to have additional science around delivering these drugs and new delivery methods. Are these drugs safe enough to administer at home and self-administer? That’s going to be something that could potentially become a wave of the future for the checkpoint inhibitors, because I do see the drugs as actually being quite safe. Other innovations are going to come from understanding why some people don’t respond and trying to fix that so that they do.”

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