Boumber is a lung cancer expert and physician-scientist at the University of New Mexico Comprehensive Cancer Center. The phase 3 clinical trial, called "Neptune," opened January 28. It compares a combination of two immune drugs with standard chemotherapy. It is one of the first clinical trials to test immune drugs as a first line treatment for lung cancer.
‘The phase 3 clinical trial, called "Neptune" is one of the first clinical trials to test immune drugs as a first line treatment for lung cancer.’
Data from phases 1 and 2 of the previous clinical trial with this immunotherapy combination showed promising results: nearly half the people responded to the drug combo. Those with side effects could manage them. And many of these people responded to the drug combo for a long periods of time, an encouraging result.
Doctors currently treat lung cancer with a chemotherapy combination of a platinum drug and another drug, says Boumber. But this treatment shrinks tumors or stops them from growing in only 40 to 50 percent of people. The chemotherapy often comes with side effects and doctors often have no way to tell which drug will help the person most when paired with the platinum drug. And in the end, the effects can be short-lived.
"Right now, with this chemotherapy approach, average survival is about 13 months from diagnosis," says Boumber. "And 80 percent of patients have to stay with chemotherapy, while for many patients, the effectiveness chemotherapy can be relatively short lived. The treatment choices that were relatively limited a few years ago, now are expanding very rapidly."
The Neptune clinical trial divides the people who join into two groups. One group receives the standard of care: chemotherapy using a platinum drug and another drug. The other group doesn't use chemotherapy as a first line treatment. It uses a new class of drugs called immunotherapy, which harnesses the person's own immune system to fight the cancer. Immunotherapy drugs can be more selective in killing cancer cells, leaving normal cells alone. Doctors can manage the serious side effects in the fewer than 10 percent of people who get them. In previous studies, immunotherapy was used only after chemotherapy failed. This clinical trial is one of the first ones to test immunotherapy as a first treatment for lung cancer.
The Neptune clinical trial tests two immune drugs: durvalumab and tremelimumab. Called "immune checkpoint inhibitors," both act on immune cells in different ways to spur them into action. Cancer tumors often shut down the immune system by sending chemical signals to immune cells. These drugs prevent those signals from affecting immune cells, leaving the immune cells free to find and kill the cancer cells. And unlike chemotherapy, the effects of these changes to the immune system can be very long-lived.
Along with the Neptune clinical trial, three other clinical trials are set to open in the next three months. The clinical trials will combine immunotherapy drugs in different ways. Some clinical trials will focus on people who have gone through chemotherapy for lung cancer. Other clinical trials will focus on newly-diagnosed people who have not received treatment yet.
"The advantage of a [clinical] trial," says Boumber, "is it gives you an opportunity to get additional therapy that you cannot get with the standard of care treatments. And these drugs have been tested for the last five years. They're safe and very technologically advanced." For the 158,000 Americans expected to die from lung cancer this year, and the 1,000 New Mexicans who fight the disease, that's great news.