MALAYSIA APPROVES LATEST LUNG CANCER TREATMENT

If you have lung cancer, your chances of surviving are greatly improved with drugs that can activate your immune system, especially when combined with chemotherapy, research has shown.

So it was welcome news when the Malaysian Ministry of Health approved last October a new lung cancer treatment that combines immunotherapy with chemotherapy. Developed by Merck, the giant US pharmaceutical company, and known as Merck Sharp and Dohme (MSD) in Malaysia, the combination therapy hit the market in January under an expanded label for the drug Keytruda.

According to the World Health Organization (WHO), lung cancer is one of the most common cancers, responsible for 1.76 million deaths worldwide. In Malaysia, it’s the third most common cancer and the most worrying since 90 percent of cases go undetected until later stages.

It also has the lowest survival rate among cancers, with five-year relative survival rates of 11 percent and a median survival rate of 6.8 months, according to MSD. This means that only 11 percent will survive five years and that patients in general will survive 6.8 months after getting the disease.

The launch of the new drug, together with earlier findings, means that doctors should change the way they treat the most common type of lung cancer so that patients can receive immunotherapy as early as possible, medical experts say.

“Immunotherapy had a drawback that some patients did not get any benefit. In fact, it was worse than chemotherapy,” said Dr Tho Lye Mun, consultant clinical oncologist at Sunway Medical Centre in Kuala Lumpur, to Global Health and Travel. “So the question was, can we combine the two treatments in order to get the best of both worlds.”

The development of the therapy was based on a study led by Dr Leena Gandhi, director of the Thoracic Medical Oncology Program at the Perlmutter Cancer Center at New York University Langone Health. Patients in the study had an advanced stage of non-squamous non-small cell lung cancer, the most common type of lung cancer. They were given an immune-activating drug called Keytruda, made by Merck, which also paid for the study, while also undergoing chemotherapy.

“What it suggests is that chemotherapy alone is no longer a standard of care,” Dr Gandhi told The New York Times. She explained that chemotherapy alone had only a “modest benefit” and could add only a few months of life, with most patients surviving about a year or less. The combination treatment is a significant improvement, she said.

Dr Gandhi’s study included 616 patients with advanced lung cancer, ages 34 to 84, from medical centres in 16 countries. They were picked at random to receive either chemotherapy plus immunotherapy or chemotherapy plus a placebo, with two thirds receiving the combination that included immunotherapy. After a follow-up of 10.5 months, estimated survival rates improved dramatically.

“In terms of the data, we have an improvement of survival over one year of 69 versus 49 percent. Translated, it’s halved the chance of dying after one year if you go over to the combination. It’s highly significant,” said Dr Tho.

“Adding chemotherapy to immunotherapy, we’ve not only seen better survival rates, but we also don’t see this initial dip in survival with immunotherapy alone,” he explained. “It takes time to activate our immune system over two to three months. In that period, the chemotherapy is killing the cancer cells while the immune system is being built up, so we have this safety net via chemotherapy.”

The treatment is administered intravenously on an outpatient basis, with each session lasting 30 minutes over a three-week period.