Does shorter immunotherapy duration benefit in NSCLC?

Question

Hi doctor,

My father was diagnosed with metastatic NSCLC lung cancer, which spread to the ninth and eighth ribs of the chest (all other organs are still not affected). Two cycles of chemotherapy were completed in the last one and a half months with 21-day intervals. Now the doctor suggested chemotherapy plus immunotherapy.

And as per the doctor, if immunotherapy works, then it will be continued for at least two years. But immunotherapy is very expensive. We do not think we can continue for up to two years, so my question is, if we continue the immunotherapy for a few months, like eight to ten months, will it give some kind of benefit compared to no immunotherapy at all?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your query and can understand your concerns.

Usually, immunotherapy plus chemotherapy is suggested for two years as per international guidelines.

Its duration can be reduced if the PET scan shows a complete response (complete resolution of disease). Then it can be stopped earlier. Also, there is upcoming evidence that immunotherapy at a reduced dose provides similar benefits as a full dose, which can help in reducing costs.

I would like to see the reports of

1. PET (positron emission tomography), CT (computed tomography).

2. NGS (next-generation sequencing) report for molecular testing.

3. PD-L1 (immunotherapy) testing.

These reports can give me an idea about the exact nature and type of lung cancer your father has.

I hope this helps.

Answer 2

Hi,

Welcome back to icliniq.com.

I read your query and can understand your concern.

1. NGS does not show any targetable mutations. In that case, immunotherapy plus chemotherapy becomes the best option.

2. Immunotherapy is generally effective if PD-L1 is positive. Need to see that report before confirming.

Reduced-dose immunotherapy has shown similar efficacy in a subset of lung cancer as well as other cancers. You can discuss this option with your oncologist. Also, I would suggest getting systemic imaging done. Ideally, PET CT or CECT (contrast-enhanced computed tomography) of the chest, abdomen, and head is used to see if the disease has spread beyond the thorax.

I hope this helps.

Kindly revert in case of further queries.