After 40 years of treatment of small cell lung cancer ushered in a new program, "immune era" under the giants set off a battle

The 35th Annual Meeting of the Society for Cancer Immunotherapy (SITC 2020) has entered the countdown for 5 consecutive days, and many pharmaceutical companies at home and abroad have pre-egendered to showcase their latest research results and progress.
, Amgen announced on the 9th the safety and effectiveness of its BiTE immunotherapy AMG757 treatment of recurring or resoccupable small cell lung cancer (SCLC) phase I clinical study data.
more than 40 years of human progress in non-small cell lung cancer, the "king of lung cancer" of small cell lung cancer research has all but stopped.
2019, Roche's Ty Sage? FDA approval for the treatment of first-line small cell lung cancer patients, only really broke the long-standing situation of small cell lung cancer only chemotherapy as an effective treatment.
the admiss of immunotherapy has opened a new chapter in the treatment of small cell lung cancer.
, there are currently four approved immunotherapy drugs for small cell lung cancer adaptations worldwide, all of which are "immune checkpoint inhibitors" such as PD-1/PD-L1 inhibitors.
market a blue sea, the giants are also scrambling to influx, but the end of the fall is the majority.
Due to the lack of basic research on small cell lung cancer, as well as the late detection of the characteristics, so that the field is still slow, but also let many pharmaceutical companies preferred the non-small cell lung cancer adaptation as a broader market.
40 years of chemotherapy, why is the first-line treatment "unchanged"? At present, lung cancer is divided into non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), of which non-small cell lung cancer accounts for about 85% of all lung cancer, small cell lung cancer accounts for about 15%.
small cell lung cancer, which accounts for a small proportion, is a more invasive type of lung cancer, with a high degree of malignancy, rapid cell proliferation, rapid progress of the disease, poor prognostication of patients and so on.
patients with small cell lung cancer often have less obvious symptoms at an early stage, and once symptoms appear, the tumor often indicates that the tumor has struck other parts of the patient's body, especially brain and liver metastasis.
this symptom also doesn't cause most patients to miss treatment time.
it is known that about two-thirds of patients with small cell lung cancer were diagnosed with extensive stage small cell lung cancer at the beginning of treatment, and have lost the opportunity to undergo surgery and can only take the standard VP16-carptin chemotherapy program.
Although this chemotherapy programme is very sensitive to small cell lung cancer, with nearly 75 per cent of patients achieving partial remission rates close to 65-70 per cent, the high recurrence rate is also a harsh reality that they have to face - about two-thirds of them relapse within a year and a half to three years of the end of chemotherapy.
patients with a total survival of less than 1 year.
the pain point of the chemotherapy programme, and pharmaceutical companies are trying to fill the gap.
In fact, Han Baohui, dean of the Chinese Lung Cancer Institute and director of respiratory medicine at Shanghai Chest Hospital, has also explored new treatments in the early years, namely, stem cell support for outer blood with high-dose chemotherapy, and this similar approach to "zeroing" bone marrow, like the treatment of blood diseases, ultimately failed because of patient inercability and drug resistance.
1970, there have been 40 Phase III clinical trials of small cell lung cancer worldwide, the vast majority of which have failed.
In an interview with Edo Health, Han Baohui said:
The treatment of small cell lung cancer has not made a breakthrough in nearly 40 years, the only clinical treatment is chemotherapy."
" he points out that there are many reasons for this, but the biggest problem is that humans do not know enough about the biological behavior of small cell lung cancer.
" First, basic research needs to be strengthened, small cell lung cancer is a group of diseases, it can be divided into several types of immunity and targeted signaling pathway, different types of treatment is different responses, these rely on second-generation gene sequencing to analyze refinement, and then compared with clinical efficacy.
, in the treatment of small cell lung cancer, is still the first-line treatment to take chemotherapy.
"Will this situation be improved in the future through immunotherapy and through a number of multi-target small molecule drugs?" We also need to do more clinical research and basic translational research.
," Admits Han Baohui.
into the era of immunity, the giant PD-1/PD-L1 began to fight in recent years, with the rapid development of immunotherapy, the human treatment against small cell lung cancer has begun a new chapter.
pointed out that the current immunotherapy of lung cancer refers to "immune checkpoint inhibitors", such as PD-1/PD-L1 inhibitors.
2019, Roche's PD-L1 inhibitor, Ty Sage? Approved for first-line treatment of small cell lung cancer, breaking through more than 40 years of bottlenecks in the field.
, Mercadon's K drug was approved in the same year for patients with small cell lung cancer who had underwent platinum-based chemotherapy and at least one other pre-treatment, but the disease continued to progress.
, which has since been compared with the "K" drug by the outside world, has long been approved for the same allergy for a year.
, despite the pace, O, which won the world's first PD-1 immunotherapy drug crown, is expanding in adaptive disorders, catching up with K in the market.
In 2019, 14 cancers were approved, and 23 adaptive K-drugs tried to take another city and compete for a wider market when they covered all of lung cancer's allergies, while first-line therapy left only small cell lung cancer.
that time, Tai Sage? In fiscal 2019, roche has contributed 1.875 billion Swiss francs (approximately 13.312 billion yuan), an increase of more than 50% year-on-year.
but the January figures disappointed Mr Mercedon a bit.
said in a news release that Pembrolizumab (K-drug) and chemotherapy first-line treatment of broad-stage small cell lung cancer Phase III study did not extend survival (OS).
, the combination of Pembrolizumab and chemotherapy improved progress-free survival (PFS) in ES-SCLC patients compared to chemotherapy alone, reaching one of the main endpoints of the Phase III KEYNOTE-604 study.
, however, the pre-set OS endpoint is not statistically significant.
a first-line treatment of the muscosa east of the river, a new player was soon welcomed - AstraZeneca's PD-L1 inhibitor, Durvalumab, the trade name: Infinfan, Imfinzi).
March 2020, based on positive results from clinical Phase 3 trial CASPIAN, which showed that infinity combined with soC platinum-etoposide demonstrated total lifetime (OS) statistics compared to standard therapy (SoC) chemotherapy With significant and clinically significant improvements, the FDA approved Infineon's first-line therapeutic drugs for adult patients with broad-stage small cell lung cancer, in combination with standard therapeutic (SoC) chemotherapy, etoposide plus carbatin or cisplatin (platinum-etoposide).
so far, it can be seen that PD-1 inhibitors O and K drugs, although also approved to treat small cell lung cancer, but are second- and third-line drugs, and PD-L1 inhibitors in this area of patient expansion has been in the forefront.
, the CASPIAN study is a randomized, open-labeled global multi-center Phase III clinical trial that included 805 patients with extensive stage small cell lung cancer treated with first-line treatment.
the clinical trial was divided into three groups: imfinzi combined standard chemotherapy (etoposide plus cisplatin or carptin), Imfinzi plus tremelimumab (anti-CTL4 antibody) plus chemotherapy group, and control group for individual chemotherapy.
, CASPIAN studies are conducted at more than 200 medical centers in 23 countries around the world, including the United States, Europe, South America, Asia and the Middle East.
the main end point of this clinical trial is total lifetime.
this study, imfinzi combined with platinum-containing chemotherapy first-line treatment ES-SCLC was awarded the world's first batch in Singapore in February this year.
the treatment is currently under regulatory review in Japan and other countries.
, lung cancer has become the most common malignant tumor in China.
year, the number of lung cancer cases in China is about 750,000.
is expected to reach 1m by 2025, and China will become the world's largest lung cancer producer.
market brought about by the unsoponsed demand, which has aroused the reverie of pharmaceutical companies at home and abroad.
2019, Ty Sage? Approved in China, it is the only tumor immunotherapy approved in China for the first-line treatment of widespread small cell lung cancer.
, which is also known as the PD-L1 inhibitor, chose the segment of stage III non-small cell lung cancer for the first stop of its China tour.
With AstraZeneta's synergy in lung cancer, Infineon, which does not have a first-in-the-nation advantage in PD-1/PD-L1 inhibitors, is not only a first-in-the-nation leader. Landing in the Chinese market, and its quarterly revenue trend is also gradually approaching Tai Sanqi? trend.
on top of this, Infineon has also begun its adaptive outreach journey.
new circuit for the development of adaptive diseases is the main direction of the current PD-1/PD-L1 inhibitor market competition.
November, the FDA granted Infineon priority approval for the first-line treatment of small cell lung cancer.
and according to media reports, a total of 161 clinical trials on Infineon are currently under way.
, clinical trials are also under way in China for the adaptation of the widespread stage small cell lung cancer, which is not systematically treated.
According to Han Baohui, CASPIAN clinical results show that chemotherapy combined with PD-L1 immunotherapy degree Valium monoantitor increased the total survival of small cell lung cancer from 10.3 months to 13.0 months, and this combination therapy was also included in the CSCO small cell lung cancer diagnosis and treatment guidelines recommended.
is accelerating abroad, domestic PD-1 / PD-L1 inhibitors naturally do not show weakness.
, according to media reports, at present, domestic PD-1/PD-L1 inhibitors to carry out clinical trials of small cell lung cancer is more focused on the field of first-line treatment.
2018, Hengrui Pharmaceuticals, Fuhong Hanxuan, Baiji Shenzhou and Junshi Bio have launched clinical Phase III trials of five products.
predictable, in the small cell lung cancer first-line treatment in the broader market, there will be a multi-force competition in the future.
Lin Yiling Source: Euro Copyright Notice: All text, images and audio and video materials on this website that indicate "Source: Mets Medicine" or "Source: MedSci Original" are owned by Mets Medical and are not reproduced by any media, website or individual without authorization, and must be reproduced with the words "Source: Mets Medicine".
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