Some lung cancer patients may be able to reasonably discontinue immunotherapy after two years, study finds
Key Takeaways
A study found that people eligible to discontinue immunotherapy treatment after 2 years may be able to do so without compromising survival rates. Currently, most eligible patients continue treatment past 2 years.
Study findings could help guide management of advanced lung cancer that is no longer progressing.
People undergoing immunotherapy for advanced lung cancer may be able to reasonably stop treatment after 2 years if their cancer has not progressed, according to a new retroactive study by researchers at Penn Medicine. The study could guide treatment duration recommendations which have been so far unknown.[]
Lova Sun, MD, MSCE, lead study author and an assistant professor of Hematology-Oncology at the Perelman School of Medicine at the University of Pennsylvania, says the study provides the best evidence to date on how a fixed 2-year immunotherapy strategy compares to an indefinite treatment strategy.
“For patients and providers considering stopping immunotherapy at two years, this data provides some reassurance that stopping treatment at two years does not appear to compromise survival,” Dr. Sun said.
The study looked at patients who had been treated for advanced non-small cell lung cancer (NSCLC), some of whom discontinued treatment after 2 years and others who maintained treatment after the 2-year mark. Of the cases reviewed, there was no statistical difference in survival rates between the two groups. Also of the cases reviewed, a majority of patients maintained treatment after 2 years, even if they had been eligible to stop at that time.[]
This was the most striking finding of the study, “indicating that the majority of patients nationwide are being continued on checkpoint inhibitor therapy beyond 2 years,” said Dr. Sun.
Setting a time limit on immunotherapy could help patients
While being at times a life-saving intervention, immunotherapy is taxing—both on the body and a person’s medical bills.
“Continuing treatment beyond 2 years in the absence of known benefit carries risks including occurrence of long-term immune-related adverse events, as well as the obvious financial cost associated with indefinite treatment with checkpoint inhibitor therapy,” said Dr. Sun.
Immunotherapy can cost about $100,000 a year or more, depending on the specific drugs a person needs and if they require multiple medications. Costs and side effects can build up over time.[]
Changing trends in care?
The study relied on observation and, therefore, should not be viewed as a “definitive answer” on whether all patients should stop or continue treatment at the 2-year mark, Dr. Sun said.
“This is a retrospective study and not a randomized controlled trial, which is our gold standard for changing clinical practice,” added Sun. “There may be residual unmeasured differences between the fixed and indefinite duration groups that we were not able to account for in our adjusted analyses.”
Still, the study findings aligned with the researchers' hypothesis that continuing immunotherapy indefinitely would not significantly benefit lung cancer patients.
It is yet to be seen how the study will influence the medical world and how it will be followed up on. However, it could influence treatment pathways for lung cancer patients who are eligible for discontinuing immunotherapy by giving patients and practitioners more peace of mind if deciding to do so.
What this means for you
A new observational study found that for patients with advanced lung cancer that was no longer progressing, discontinuing immunotherapy after 2 years did not impact their survival rate in comparison to people who continued treatment for longer. The study findings could help guide treatment decisions for people unsure whether or not to continue immunotherapy treatment.