New drug offers greater hope for some patients with lung cancer
For the vast majority of patients with lung cancer, advances in treatment have been minimal. Chemotherapy remains the standard of care, and for those whose cancer worsens during or after initial treatment, the outcome of so-called second-line therapy has been poor: Only about 10 percent of patients show any improvement, and the average length of survival is several months.
That makes the Food and Drug Administration’s approval of ramucirumab last year for the treatment of non-small-cell lung cancer (NSCLC) particularly significant. The approval came after a multiyear, Phase 3 clinical trial at UCLA and other centers in 26 countries on six continents showed that for patients undergoing second-line treatment, adding ramucirumab to the standard regimen with the drug docetaxel improved outcomes. It was the first study in a decade to demonstrate a survival benefit in people with NSCLC whose cancer had progressed after their initial treatment.
“This is the first time that adding to standard second-line therapy has improved outcomes,” says UCLA oncologist Edward Garon, MD. “We are pleased to have access to a drug that lengthens survival time in a population of lung-cancer patients who often have few treatment options.”
Since 2000, chemotherapy with the single drug docetaxel has been the cornerstone of second-line treatment for NSCLC patients. The study, which involved more than 1,200 people with NSCLC whose disease had worsened during or after first-line chemotherapy, tested whether adding the experimental drug to the standard treatment would improve outcomes for these patients. Ramucirumab is an antibody that targets an important protein in the formation of vessels that supply blood to cancer cells.
The percentage of patients who responded to treatment and the period of time before the disease worsened were both greater when ramucirumab was added to docetaxel vs. what was seen with docetaxel alone, Dr. Garon says. In the study, 23 percent of patients responded to the combination of ramucirumab and docetaxel, meaning that their tumors shrank more than a specific threshold used in clinical trials. Overall, the median survival was more than 10 months.
In the future, Dr. Garon says, ramucirumab will be evaluated in combination with other drugs to treat lung cancer. Efforts are also underway to understand which patients are most likely to benefit when ramucirumab is added to docetaxel.
Considering how many deaths it causes, funding for lung cancer research lags behind other common malignancies — a result, many lung-cancer researchers suspect, of the unfortunate societal perception that because of its association with smoking, lung cancer is a self-induced disease.
“There is a stigma and shame that keeps many patients from talking about it,” Dr. Garon says. “But we have to remember that our understanding of the dangers of smoking evolved and that, in fact, most lung cancers are diagnosed in former smokers — people who processed the information, did quit, but who still are subjected to the disease. Others never smoked. Certainly it is important to have anti-smoking campaigns to try to prevent people from ending up with smoking-related lung cancer, but we would hope that they not be at the expense of adding a stigma to people who are struggling with the disease.”