Lung cancer is a major global health concern that has a significant impact on the morbidity and mortality of affected individuals. It is the leading cause of cancer-related deaths in both men and women worldwide.

According to the World Health Organization (WHO), 1.8 million people worldwide die every year from lung cancer, with smoking being the leading cause of the disease. Despite advances in the diagnosis and treatment of lung cancer, the survival rate for lung cancer patients remains low, especially for those with advanced stages of the disease.

Therefore, there is a critical need for more efficacious lung cancer treatments.

The Role of Immune and Chemotherapy in Lung Cancer Treatment

Immune and chemotherapy are two treatment modalities that have shown promise in the treatment of lung cancer. Chemotherapy uses cytotoxic agents to kill rapidly dividing cells, including cancer cells.

A variety of chemotherapy agents are used to treat lung cancer, including platinum-containing drugs such as cisplatin and carboplatin, as well as taxanes, vinca alkaloids, and etoposide.

Immunotherapy, on the other hand, uses the immune system to fight cancer by activating T-cells, which are a type of white blood cell that can target and destroy cancer cells.

Immune checkpoint inhibitors (ICIs) are a type of immunotherapy that target proteins that help cancer cells evade the immune system.

The Potential of Combination Therapy

Both immune and chemotherapy have their advantages and limitations in the treatment of lung cancer. However, recent research has shown that combining these two modalities can produce synergistic effects that enhance treatment efficacy.

Combination therapy can take different forms, including:.

Sequential Therapy: this involves administering chemotherapy first, followed by immunotherapy.
Concurrent Therapy: this involves administering both modalities simultaneously.
Switch Therapy: this involves starting with one modality and switching to the other, depending on the patient’s response.

How Combination Therapy Works

Combining immune and chemotherapy in the treatment of lung cancer has several advantages. Chemotherapy can create a favorable environment for the immune system by killing cancer cells and releasing antigens that can activate T-cells.

In addition, chemotherapy can reduce the number of regulatory T-cells, which suppress the immune response and promote tumor growth. Therefore, chemotherapy can enhance the effectiveness of immunotherapy by reducing tumor burden and promoting T-cell activation.

Evidence for Combination Therapy Efficacy

Several clinical trials have investigated the efficacy of combining immune and chemotherapy in the treatment of lung cancer.

One such trial is the KEYNOTE-189 trial, which evaluated the combination of the chemotherapy drugs pemetrexed and platinum with the ICI pembrolizumab. The trial demonstrated significant improvements in progression-free survival (PFS) and overall survival (OS) in patients with non-squamous non-small cell lung cancer (NSCLC) compared to chemotherapy alone.

Another trial, the IMpower150 trial, evaluated the combination of the chemotherapy drugs carboplatin and paclitaxel with the ICIs atezolizumab and bevacizumab. The trial demonstrated significant improvements in PFS and OS compared to chemotherapy alone in patients with NSCLC.

Limitations of Combination Therapy

Despite the potential benefits of combining immune and chemotherapy in the treatment of lung cancer, some limitations need to be considered. First, combination therapy can lead to increased toxicity, which can affect the patient’s quality of life.

Second, some patients may not respond well to combination therapy, and their disease may progress rapidly. Therefore, more research is needed to identify biomarkers that can predict treatment response and guide treatment selection in patients with lung cancer.

The Role of Combination Therapy in Neoadjuvant Treatment

Neoadjuvant treatment is the use of chemotherapy or radiation therapy before surgery in patients with early-stage lung cancer.

The main goal of neoadjuvant treatment is to reduce the size of the tumor and increase the likelihood of a complete resection during surgery. Combination therapy has shown promise in enhancing the effectiveness of neoadjuvant treatment in lung cancer. Several clinical trials have investigated the role of combination therapy in neoadjuvant treatment, with promising results.

For example, the LCMC3 trial evaluated the use of the combination of cisplatin and pemetrexed with the ICIs nivolumab and ipilimumab in patients with resectable NSCLC. The trial demonstrated a high pathological response rate (major pathological response rate; MPR) in patients who underwent surgery after neoadjuvant treatment.

The Importance of Multidisciplinary Care

Combining immune and chemotherapy in the treatment of lung cancer requires a multidisciplinary approach that involves medical oncologists, radiation oncologists, and surgeons.

The selection of the appropriate treatment modality and the sequencing of therapies require careful consideration based on the patient’s individual characteristics, including the stage and histology of the tumor, as well as comorbidities and treatment-related toxicity. Therefore, a coordinated care approach is needed to ensure that patients receive the most effective and safe treatment possible.

Conclusion

The combination of immune and chemotherapy has emerged as a promising treatment modality in the management of lung cancer.

Combination therapy can produce synergistic effects that enhance treatment efficacy and can be used in both advanced-stage and early-stage disease. However, the selection of the appropriate treatment modality and sequencing of therapies requires careful consideration based on the patient’s individual characteristics.

Therefore, a multidisciplinary approach is essential to ensure that patients receive the most effective and safe treatment possible.