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When Metastatic Lung Cancer Patients Should Stop Using Immunotherapy

Metastatic lung cancer patients should continue with immunotherapy for up to 2 years if they are responsive and are not experiencing excessive toxicity or disease progression.

Initially, stage III lung cancer patients usually undergo immunotherapy for one year as established in one clinical trial. The trial results showed that durvalumab (imfinzi) could prolong overall survival and progression-free survival in stage III unresectable non-small cell lung cancer compared to placebo in patients who didn’t have disease progression after concurrent chemoradiotherapy.

However, there are rules for those patients undergoing immunotherapy for metastatic disease. If they experience excessive toxicity or progression of the disease, they should stop taking the drugs. But if they have a response, they can continue with treatment for up to 2 years. At this time, the doctors will have to talk to the patient to explain the downsides and upsides of stopping or continuing with therapy.

Based on data from another trial, about two-thirds of patients who took pembrolizumab (Keytruda) for two years remained responsive to treatment even after it was stopped. After 43 months of follow-up, it was observed that pembrolizumab continued to prolong the overall survival versus docetaxel in patients who were previously treated with PD-L1-expressing advanced non-small cell lung cancer with manageable long-term safety. Most of the patients who completed all the 35 cycles of pembrolizumab during the trial had a durable response to treatment.

Treatment is often stopped when patients experience chronic adverse effects, such as arthralgias or fatigue. Patients start experiencing mild effects in the first few months, but later they’d have severe experiences, including transaminitis or pneumonitis. Endocrinopathies (thyroid) is also common but can be managed.

Scientists are working to determine which patient can benefit from these approaches. They are looking for clinical characteristics or biomarkers that could help identify patients who qualify for chemotherapy alone. That’s why biomarker research is ongoing to help them get the algorithms that’ll guide their decision making.

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