"Patients with newly diagnosed advanced lung cancer who received an immunotherapy drug plus standard chemotherapy lived significantly longer than those who got chemo alone according to a new study that is expected to change the way such patients are treated. The report was one of several highly anticipated studies on immunotherapy and lung cancer presented Monday at the annual meeting of the American Association for Cancer Research in Chicago. The studies simultaneously were published by the New England Journal of Medicine on a day that some experts called the Super Bowl of lung cancer immunotherapy. The reports underscore the increasingly important firstline role that immunotherapy https_story.htmlutm_term.afa which unleashes the immune system to destroy cancer cells is taking against the deadliest cancer. Immunotherapy is rapidly in combination with other treatments and on its own dramatically changing the standard of care for lung cancer said Leena Gandhi an oncologist at NYU Langone Health who led the study on the immunotherapychemotherapy combination called Keynote. Instead of chemo being the backbone on which to improve immunotherapy is now the backbone on which we build. Lung cancer is the secondmostcommon malignancy https_story.htmlutm_term.afaaf in the United States after breast cancer. The American Cancer Society estimates that  people will be diagnosed with the disease this year and  will die of it. Most patients diagnosed with advanced lung cancer  disease that has spread beyond its original site  initially receive chemotherapy which provides only marginal benefit. But the disease is so lethal that many patients dont survive long enough to try second or thirdline treatments so researchers are trying to develop and use more effective approaches earlier. The trial that grabbed much of the spotlight Monday is a randomized effectiveness study that involved more than  untreated patients with advanced nonsquamous nonsmall cell lung cancer  a common type of the disease. The patients did not have cancercausing mutations. One group was treated only with chemo while the other got an immunotherapy drug called Keytruda https_story.htmlutm_term.efec plus chemo. Some of the results had been released previously but not specific details.After a median followup time of . months Gandhi said the patients in the combination group were  percent less likely to die compared with patients in the chemoonly arm. For the first time adding another drug has significantly impacted the longterm outlook for those patients she said. Scientists who werent involved in the study agreed that it was highly significant. H. Jack West an oncologist at Swedish Medical Center in Seattle said It is literally practicechanging  immediately. Roy Herbst an oncologist at Yale Cancer Center said that most lung cancer patients now will be offered immunotherapy in some form much earlier than before. Still he said the approach was not a cure and there is a lot of room for improvement. The estimated proportion of patients in the combination therapy group who were alive and whose disease had not gotten worse at a year was about  percent about double the proportion for the chemoonly group. Last May the Food and Drug Administration approved the Keytrudachemo combination based on an earlystage trial. But many doctors did not adopt it because the trial was small and didnt initially show a survival benefit Gandhi said. Experts said it was especially significant that the study showed that patients benefited from the Keytrudachemo combination regardless of the levels of a protein called PDL found on their cancer cells. Researchers already had known https_story.htmlnoredirectonutm_term.adea that patients with high levels of the protein were more likely to respond to immunotherapy. Last week in a related development Merck which makes Keytruda reported that a different trial showed that the medication prolonged survival even when used alone compared with chemo. Experts said they will have to see more details before they can determine whether the medication is better used alone or with chemo. In a second study published Monday researchers used two other immunotherapy medications  Opdivo and Yervoy both made by BristolMyers Squibb  to treat newly diagnosed patients with advanced nonsmall cell lung cancer with a high number of mutations in their tumors. The patients experienced a significantly longer period during which their disease did not worsen compared with people who received only chemotherapy said Memorial Sloan Kettering Cancer Center oncologist Matthew Hellmann who led the study. He said the results established the doubleimmunotherapy combination as a firstline treatment for patients with a high tumor mutational burden but that it was too early to know whether the treatment leads to longer survival. And he said the trial showed that tumor mutational burden is a reliable way to predict who will benefit from the medications. Another study published Monday used immunotherapy in a different way  for  patients with earlystage lung cancer. Researchers at Johns Hopkins and Memorial Sloan Kettering gave patients two doses of Opdivo  the first a month before surgery the second two weeks before the operation  to try to stimulate antitumor activity and reduce the risk of relapse. Nine of the  patients who got Opdivo had a major pathologic response  a sharp reduction in the number of cancer cells found in the tumors removed by surgery. Drew Pardoll director of Hopkins BloombergKimmel Institute for Cancer Immunotherapy said that it is too early to know whether the findings will translate into longer survival. But if future studies show that he added then immunotherapy might be used to augment or even replace chemo typically given before surgery."