Patients with small-cell lung cancer without metastases outside the chest cavity (LS-SCLC) survive on average almost 2 years longer if they receive 2 years of immunotherapy after standard treatment. This emerges from the global ADRIATIC study led by radiation-oncologist Suresh Senan of Amsterdam UMC, Cancer Center Amsterdam: “For decades, the treatment for these patients has remained the same. This study shows that they should receive additional immunotherapy.”

In most patients in whom small-cell lung cancer is detected at an early stage, the standard treatment of chemotherapy with radiation works well. The cancer disappears completely, the tumor gets smaller or the number of tumors decreases. After treatment, patients receive regular checks. However, the prognosis remains poor, as the cancer often returns within 2 years. Researchers wanted to know if immunotherapy after standard treatment could change this poor prognosis.

Immunotherapy blocks the activity of a protein called PD-L1, making it easier for immune cells to fight and kill cancer cells. In 2018, the ADRIATIC study began in patients who had completed standard treatment with chemotherapy and radiation: for 2 years, 730 patients from 164 centers in 19 countries received either immunotherapy or a placebo every four weeks.

First results ADRIATIC study

The results of the phase III study are promising. Patients who received immunotherapy had an improvement in overall survival of 22.5 months compared with patients receiving placebo. The avarage risk of death decreased by 27% compared with patients on placebo. Patients also had a higher chance of living longer without the cancer growing again. The average risk of cancer recurrence or death was 24% lower with the immunotherapy, compared with placebo. Immunotherapy did cause side effects, but they did not usually lead to treatment discontinuation.

The numbers speak for themselves. Such a large degree of improvement is rare.”
Prof. dr. Suresh Senan
Professor of clinical experimental radiotherapy Radiation-oncologist

Recommendation

The data from the ADRIATIC study support immunotherapy as a new treatment option for patients with LS-SCLC whose tumors have disappeared, shrunk or remained stable after the standard treatment of chemotherapy with radiation. Therefore, the researchers recommend the additional treatment for this patient group. However, before such a treatment can be applied in the Netherlands, the drug must first receive European approval and then be reimbursed in the Netherlands. The results were presented Sunday, June 2nd, at the American Society of Clinical Oncology (ASCO) congress in Chicago.

This article was created for Cancer Center Amsterdam.

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