Researchers at the 2024 ASCO Annual Meeting have announced the longest progression-free survival rates ever reported in advanced lung cancer. Patients with an incurable form of lung cancer were able to lead normal lives by taking a daily pill that “stops cancer in its tracks.”
Our fight against cancer has come a long way. The 5-year relative survival rate for all cancers has improved from 58% during the mid-1970s to 85% in 2018 — and advances keep coming. But there’s still a long way to go, particularly when it comes to dealing with aggressive types of cancer, like lung cancer.
Globally, lung cancer is the world’s leading cause of cancer death, killing 1.8m people every year. Survival rates in patients with advanced cancer progression are particularly poor. But a new drug may finally turn the tide.
Impressive results
The drug is called lorlatinib, pronounced lor-la-tih-nib. In the new trial, 296 patients with advanced forms of non-small cell lung cancer were split into two groups where they were either assigned to receive either lorlatinib (149 patients) or another drug called crizotinib (147 patients, of whom 142 ultimately received treatment).
The researchers measured the progression-free survival (PFS) of patients. This is basically the length of time during and after treatment that a patient lives with the disease and it does not get worse. It is one way of seeing how the well treatment is working.
In this case, it was striking. Around 60% of the patients who took lorlatinib were still alive five years later with no progression in their disease. Meanwhile, the rate was only 8% with the standard drug.
“The PFS is outstanding; we have not seen anything close to this. Other great drugs that are available including alectinib [Alecensa] and brigatinib [Alunbrig] have not reported durable PFS events of this magnitude,” David R. Spigel, MD, a medical oncologist and the chief scientific officer at Sarah Cannon Research Institute in Nashville, Tennessee, added in a discussion of the data.
Researchers who were not involved in the study also hailed the results, saying that they’re “unprecedented” and “off the charts”.
“These results speak to the ability of lorlatinib not only to prevent progression of existing brain metastases, but to prevent or delay progression of new brain metastases,” said Benjamin J. Solomon, a medical oncologist at Peter MacCallum Cancer Centre in Melbourne, Australia, in a presentation of the data. “The systemic efficacy results coupled with prolonged intracranial efficacy from first line lorlatinib treatment indicate that this provides an unprecedented improvement in outcomes for patients with advanced ALK-positive NSCLC.”
Room for progress
There were some side effects. In patients treated with the new drug, 77% had treatment-related issues, the most common of which were swelling, high cholesterol, and elevated lipids. But, in the grand scheme of things, these are relatively minor when drug essentially gives patients a way to stop cancer in its tracks.
Lorlatinib is a type of targeted drug called a tyrosine kinase inhibitor. These tyrosine kinases are proteins that the body uses as signals. Different cells receive inputs from tyrosine kinases about when and how to grow. So, blocking these signals helps to stop or slow cancer cell growth. The drug is taken as a tablet, swallowed with water.
This is not the first drug of this type, but it is one of the most promising ones, particularly for this type of condition. While lorlatinib has to be tested in larger trials to truly gauge its success rate, Cancer Research UK’s chief clinician, Prof Charles Swanton, told The Guardian that results would offer fresh hope for lung cancer patients.
“Despite progress in our understanding of the disease, it can be incredibly challenging to control cancers that have spread and there are limited treatment options for lung cancer,” he said.
“Showcasing the power of cancer-growth blocker drugs, this study could present us with an effective way of stopping cancer in its tracks and preventing it from spreading to the brain.”
Journal Reference: Solomon BJ, Liu G, Felip E, et al. Lorlatinib vs crizotinib in treatment-naïve patients with advanced ALK+ non-small cell lung cancer: 5-year progression-free survival and safety from the CROWN study. J Clin Oncol. 2024;42(suppl 17):LBA8503. doi:10.1200/JCO.2024.42.17_suppl.LBA8503
