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Immunotherapy Moves to the Front Lines in Fight against Lung Cancer

Original article posted on the  Washington Post

Lung cancer, which kills almost 160,000 Americans a year, is among the cruelest of foes. Most patients are diagnosed at an advanced stage and after punishing chemotherapy still have a bleak prognosis. More than half die within a year.

Bit by bit, though, scientists are making progress against the nation’s biggest cancer killer. Years ago, they began approaching lung cancer as many different diseases rather than a single one. The 15 percent of patients with certain high-risk mutations, for example, today get “targeted” medications that work better than chemo.

This “divide-and-conquer” strategy, as one researcher describes it, is poised to make an even bigger advance — one that involves the immunotherapy drug used as part of former president Jimmy Carter’s successful treatment for advanced melanoma. It could benefit tens of thousands of patients in the United States alone — as many as one-third of those diagnosed at a late stage with the most common form of the disease.

The treatment shift stems from a major international trial in which the drug, Keytruda, beat chemo on both effectiveness and safety in patients who have advanced cancer and a high concentration of a specific protein on their tumors. The Food and Drug Administration last month approved Keytruda as a first-line treatment for such ­cases, the first time that immunotherapy has been given the green light as an initial treatment for lung cancer.

The result: Most new patients will be tested for the protein, called PD-L1. If they have a high level on their cancer cells, they will receive Keytruda rather than chemo, which is much more debilitating, oncologists say.

“We don’t want to oversell this, but for someone like me who has worked in the trenches for years, this is a big deal,” said Julie Brahmer, who led the clinical trial and is an oncologist at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. “I have had one patient on this [drug] for five years, and she has seen her daughter graduate from high school and college.”

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