Safe to Stop Immunotherapy at 2 Years in Stable Lung Cancer

Core Concepts

It is safe to discontinue immunotherapy after 2 years in progression-free NSCLC patients.

Abstract

The content discusses the safety of stopping immunotherapy after 2 years in non-small cell lung cancer (NSCLC) patients who are progression-free. A review of clinical trial data suggests that there is no significant difference in overall survival between patients who stop immunotherapy at 2 years and those who continue for another 2 years. The study was published in JAMA Oncology and presented at the ASCO Annual Meeting. Key points include:

• Safety of stopping immunotherapy after 2 years in progression-free NSCLC patients.
• Lack of significant overall survival advantage for indefinite treatment.
• Durable benefits observed after stopping immunotherapy at 2 years.
• Considerations for discontinuing treatment based on cost, toxic effects, and patient well-being.
• Study details comparing overall survival in patients treated with upfront ICIs for 2 years vs beyond 2 years.
• Rechallenging patients with ICIs after progression.
• No funding for the work and disclosures of pharmaceutical industry ties.

Stats

"Two-year overall survival from the 760-day mark was 79% in the fixed-duration group vs 81% with indefinite treatment."
"Median progression-free survival after rechallenge was 8.1 months."

Quotes

"For patients who are progression-free on immunotherapy for NSCLC, it is reasonable to stop therapy at 2 years, rather than continuing indefinitely." - Investigators
"In the meantime, the perfect should not be the enemy of the good. These data may provide reassurance to us and patients that discontinuing treatment at 2 years can confer the same overall survival as extended treatment with lower risk of toxic effects, less time in treatment for patients, and considerably lower costs for our healthcare system." - Jack West, MD

Key Insights Distilled From

Safe to Stop Immunotherapy at 2 Years in Stable Lung Cancer

by M. Alexander... at www.medscape.com 06-06-2023

https://www.medscape.com/viewarticle/992825

Deeper Inquiries

How might the findings of this study impact current treatment guidelines for NSCLC patients

The findings of this study could significantly impact current treatment guidelines for NSCLC patients by potentially leading to a shift towards a more personalized approach to immunotherapy duration. If it is deemed safe to stop immunotherapy after 2 years in stable patients, guidelines may be updated to reflect this new evidence. This could result in reduced overtreatment, lower healthcare costs, and decreased risk of toxic effects for patients. Clinicians may be more inclined to discontinue treatment at the 2-year mark, especially in cases where patients are progression-free, based on the reassurance provided by the study's results.

What are the potential drawbacks of discontinuing immunotherapy at 2 years, considering the durable benefits observed after stopping treatment

While the study suggests that it is safe to discontinue immunotherapy at 2 years in stable NSCLC patients, there are potential drawbacks to consider. One drawback is the possibility of losing the durable benefits observed after stopping treatment. Some trials have shown that patients can experience long-lasting benefits even after discontinuing immunotherapy. Therefore, stopping treatment at 2 years may result in missing out on these extended benefits and potentially compromising long-term outcomes for some patients. Additionally, there is a risk of disease progression or relapse once treatment is stopped, which could have negative implications for patient outcomes.

How can the healthcare system adapt to the changing landscape of immunotherapy duration in lung cancer treatment

To adapt to the changing landscape of immunotherapy duration in lung cancer treatment, the healthcare system can implement several strategies. Firstly, healthcare providers can update treatment guidelines based on the latest evidence, such as the findings of this study, to ensure that patients receive the most appropriate and effective care. This may involve developing personalized treatment plans that take into account individual patient factors, including response to immunotherapy and risk of disease progression. Additionally, healthcare systems can invest in ongoing monitoring and surveillance of patients who discontinue immunotherapy at 2 years to promptly detect any signs of disease recurrence or progression. This proactive approach can help mitigate the potential risks associated with stopping treatment early and ensure that patients receive timely interventions if needed. Furthermore, healthcare providers can engage in shared decision-making with patients to discuss the benefits and risks of discontinuing immunotherapy at 2 years, allowing patients to make informed choices about their treatment journey.