Survey Says Immunotherapy May be Effective for Early-Stage Cancer Treatment
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Immunotherapy, which is used to prevent, control and eliminate cancer by harnessing the body's immune system, has several important features making it an effective cancer treatment method.
In a recent multinational survey, healthcare providers expressed the belief that immunotherapy will improve outcomes for patients with earlier-stage cancers in the adjuvant, neo-adjuvant and peri-operative settings, if approved by regulatory bodies.
Its ability to recognize and target cancer cells makes immunotherapy attractive as a potentially universal therapy for cancer. Many types of tumors can be treated with cancer immunotherapy, which is focused on the immune system and may be more targeted than conventional cancer treatments such as chemotherapy or radiation. Immune therapy has proved to be particularly effective with melanoma patients when chemotherapy and radiation have not worked.
Hundreds of oncologists, surgeons and specialists across the U.S., Japan, Germany, Italy and France who currently treat patients with up to eight different types of stage I-III cancer were surveyed by Bristol Myers Squibb.
Several trends were identified regarding current treatment choices, satisfaction with treatment and the factors influencing treatment choices in early-stage cancers. The treatment of tumors in the neoadjuvant, adjuvant, or perioperative setting consists of chemotherapy, radiation, targeted therapy, chemoradiation therapy and increasingly, immunotherapy, depending on the type of tumor.
Most healthcare providers (HCPs) surveyed report that they do not always use treatments beyond operation. The majority of surgeons reported the use of neoadjuvant (62%), adjuvant (55%) or peri-operative (54%) treatments occasionally for patients with early cancer stages, highlighting the importance of earlier intervention.
In cancers where earlier options are well established, HCPs are more satisfied with current treatments. In the survey, six out of 10 respondents say they are "very" or "fairly" satisfied with the current neoadjuvant (67%), adjuvant (70%) and perioperative (61%) treatment options. The satisfaction levels vary by tumor but are highest for cancers with well-established therapies, like breast cancer (87% in neoadjuvant/adjuvant settings) and melanoma (77% in the adjuvant setting).
For patients with kidney and liver cancers, HCP satisfaction is considerably lower, to the tune of less than 35% in all settings, indicating that additional research is needed here.
Respondents were asked to discuss their perceptions of immunotherapy to gain a fuller understanding of the potential future treatment landscape. Overall, HCPs appear optimistic about the potential impact of immunotherapy at earlier stages of disease.
The recurrence of cancer can be life-altering for patients, noted Dr. Michele Maio, director of medical oncology and immunotherapy at University Hospital of Siena.
“Optimizing cancer treatment in its early phases, before the disease returns or spreads, represents a significant opportunity and unmet need," Maio said.
Researchers are actively studying immunotherapy in these settings, and the survey results have confirmed the optimism of most HCPs, he added.
According to respondents, immunotherapy is used in earlier stages of cancer (both in clinical trials and as approved therapies). The majority of respondents report more experience with chemotherapy (85%, 86% and 73% for neoadjuvant, adjuvant and peri-operative respectively) than immunotherapy (48%, 65% and 39%), likely reflecting the fact that immunotherapy has only recently become approved for certain types of tumors.
According to BMS SVP and Head of Oncology Development Jonathan Cheng, immunotherapy research has evolved over the past decade from a focus on metastatic cancer to exploring how these treatments might be used earlier in the disease course.
"We hope that by addressing cancer in earlier stages, when the immune system may be more responsive and intact, immunotherapy may have the potential to prevent recurrence and ultimately lead to patients living longer," he added.
Recently, Bolt Biotherapeutics announced a partnership with BMS on a new combination of two of the companies' main drugs, representing a new type of cancer immunotherapy that combines the deadeye aim of antibody targeting with the strength of the innate and adaptive immune systems.
BMS is pursuing new therapies by advancing research into cell therapy, immuno-oncology and protein homeostasis along with other novel platforms.
In August last year, Health Canada approved Opdivo (nivolumab) plus Yervoy (ipilimumab) combined with limited chemotherapy for the treatment of Metastatic Non-Small Cell Lung Cancer (NSCLC), marking the availability of the first dual immuno-oncology plus limited course chemotherapy NSCLC treatment in Canada.