'We are going to have lung cancer patients living longer and better:' A new kind of cancer treatment is about to change how we treat the disease (MRK, BMS)

  • New cancer treatments that harness the body's immune system are ready to go mainstream. 
  • In data presented Monday at the American Association of Cancer Research's annual meeting, cancer drugmakers showed that the use of immunotherapy in combination with other drugs did a better job of treating lung cancer than chemotherapy alone. 
  • A combination of Merck's immunotherapy drug, Keytruda, and chemotherapy cut the risk death in lung cancer patients by half. 
  • The results could massively impact the way hundreds of thousands of lung cancer patients are treated, by making immunotherapy part of the standard treatment.

A new kind of cancer treatment that harnesses the body's immune system, known as immunotherapy, is going mainstream.

In data presented Monday at the American Association of Cancer Research's annual meeting and published in the New England Journal of Medicine, Merck showed that a combination of the immunotherapy Keytruda with chemotherapy was able to extend the lives of people with a common form of lung cancer compared to traditional chemotherapy, cutting the risk of death by half.

At the same time, Bristol-Myers Squibb, which makes a competing immunotherapy, Opdivo, showed that its drug in combination with Yervoy, another immunotherapy, managed to keep lung cancers that had a certain amount of mutations from getting worse for a longer period of time than those treated with chemotherapy. 

Merck is up 2.3% on Monday morning, while BMS is down 5.3%.

RELATED: Things in your home that can cause cancer: 

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Things in your home that can cause cancer
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Things in your home that can cause cancer

Your big, comfy couch

Your favorite sofa could be killing you, and not just because it lures you away from activity: Many sofas, mattresses, and other cushioned furniture are treated with TDCIPP, a flame retardant known to cause cancer (i.e., a carcinogen). TDCIPP was used so frequently prior to 2013 that a study out of Duke University found it in the blood of everyone they tested. It's also one of ten chemicals most frequently found in household dust, according to this study.

What can you do?

Consider replacing cushioned furniture you purchased prior to 2013, according to the Natural Resources Defense Council—and check furniture labels on any purchases.

And while you're at it, make sure you aren't around any of these other causes of cancer.

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Your curtains and carpets

Cadmium is a carcinogenic byproduct of cigarette smoke. If you smoke in your house, cadmium and other cigarette smoke by-products may be lurking, especially on soft surfaces such as curtains and carpet—even long after the smell of smoke is gone. There's even such a thing as third-hand smoke and it's resistant to even the strongest cleaning products. Here's where you can learn more about third-hand smoke and its dangers.

What can you do?

Quit smoking—here are 23 tips to kick start kicking the habit—and never allow smoking in your home.

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Your leather recliner

Chromium (VI) is a known carcinogen found in tanned leather, wood furniture, certain dyes and pigments used in textiles, and cement. To give you an idea of the prevalence of chromium VI, one study out of Denmark found that almost half of imported leather shoes and sandals contained some level of the carcinogen.

What can you do?

As with TCIPP, pay attention to labeling. And don't be shy about asking questions of your furniture salesperson.

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Your garden

Dioxin is a carcinogen that forms as a chemical byproduct and ends up in our soil and water. It's in the dust on shelves, the dirt on floors, and the residue on vegetables. Your risk of cancer from dioxin exposure may be greater than one in one-thousand, says clean-living guru, Sophia Ryann Gushée.

What can you do?

Wear gloves when working in the garden, and always wash up before heading inside. Additionally, avoid backyard burning of household trash.

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Your old fridge

According to cancer.org, carcinogenic PCBs can turn up in old appliances, fluorescent lighting fixtures, and electrical transformers. While no longer commercially produced in the United States, PCBs are still manufactured and used in developing countries, and of all PCBs ever produced, up to 70 percent are still in the environment. Diet is another major source of exposure, according to Gushée.

What can you do?

Get rid of those old appliances and fluorescent light fixtures. Pay attention to advisories regarding PCB-contaminated fish and fish-eating wildlife.

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Your cleaning products

Formaldehyde is a known carcinogen found at home in food, cosmetics, a variety of cleaning products (such as dishwashing liquids, fabric softeners, and carpet cleaners), paint, foam insulation, and on permanent press fabrics. In addition, you can be exposed by breathing smoke from gas cookers and open fireplaces.

What can you do?

Here is a list of household products that contain formaldehyde, according to the U.S. Department of Health and Human Services. Choose your cleaning products carefully—here are some chemical-free ways to clean your home. Also, be sure to ventilate your cooking areas.

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Your closets

The dry-cleaning chemical perchloroethylene (tetrachloroethylene or "perc") is a carcinogen that can build up wherever you store your dry-cleaned clothes. It's also found in spot removers, shoe polish, and wood cleaners.

What can you do?

Wear gloves when polishing your shoes and cleaning wood. If you dry-clean your clothing, try to find a dry-cleaner who doesn't use perc. And check out the times you can feel free to ignore the dry-clean only label.

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Your vinyl flooring and miniblinds

Phthalates are suspected of causing cancer and may adversely affect human reproduction or development. They're found in vinyl flooring, shower curtains, synthetic leather, miniblinds, wallpaper, and anything made with PVC vinyl. They're also found in food packaged in plastic.

What can you do?

Stay away from products made with PVC vinyl. Look for products that are labeled as phthalate-free. Toss plastic toys made before 2008, according to mindbodygreen.com, and switch to glass and stainless containers and bottles. And reconsider your use of plastic wraps and food containers.

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Your favorite rice and chicken dinner

Everyone knows arsenic is poisonous, but in smaller doses, it's also carcinogenic. Yet you can find it in foods you probably eat regularly—including chicken, rice, and certain fruit juices, as well as in degreasing products, dyes, furniture wax, glues, lubricants, nylon, and paints.

What can you do?

Serve only organic chicken, and follow these rice-related guidelines issued by Consumer Reports. Check the labels on your household products; people following a gluten-free diet may be at particular risk of arsenic exposure.

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Your insulation

Asbestos has been out of favor for decades, thankfully, but you can still find it in the insulation of older homes. As the insulation eventually deteriorates, asbestos fibers become airborne. Since asbestos fibers stick to clothing and shoes, workers exposed to asbestos on the job can also bring asbestos into their homes.

What can you do?

Follow these guidelines to reduce asbestos exposure in your home.

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Your styrofoam cups

Styrene is a known carcinogen widely used in the manufacturing of polystyrene plastics, which can be made into foam and rigid plastic products such as cups, plates, trays, utensils, packaging, and packing peanuts. Styrene may leach into your hot coffee or soup if you're using styrofoam containers. It's also present in cigarette smoke and in all of these home maintenance, automotive, and crafting productsWhat can you do? Avoid using styrofoam to hold hot foods and liquids, and read your product labels carefully. Find out the 12 foods you should never microwave.  

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Your library books

According to the Library of Congress and other government sources, medical supplies, library books, and museum artifacts may all be sterilized or fumigated with ethylene oxide, which is a known carcinogen. What can you do? Mostly a problem for people who work with the chemical, you can minimize exposure by not bringing items into your house that have been exposed to ethylene oxide.

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Your weedkiller

No one likes weeds, but if you decide to decimate them using herbicides such as Roundup, which contains the carcinogen glyphosate, you may be raising your risk for cancer.

What can you do?

Make a practice of carefully reading the labels on your weedkillers. And consider using some of these natural weed killers that don't contain dangerous chemicals.

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Your bug spray

Pantry pests and other creepy crawlies can carry disease. But if you eliminate them using chemical pesticides, you're increasing your risk of cancer. Chemical pesticides include those that you use on your pets, such as flea collars and tick-repellant.

What can you do?

Seek out less-toxic pesticide alternatives—or make your own, like this natural tick repellent that works.

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Your granite counter

Radon is formed naturally from the radioactive decay of uranium in rocks and soil. It raises the risk of lung cancer—especially if you also smoke, says Ashley Sumrall, MD, FACP, a Charlotte-based oncologist. If you live in an area where the amount of uranium and radium in rocks is high, you can be exposed to radon through cracks in your foundation. You can also be exposed to radon if you have a granite countertops.

What can you do?

If you live in an area with high levels of uranium and radium, or if you have granite countertops, consider having your home's radon levels measured. Here's what you need to know about radon testing.

Next, find out the causes of cancer that might surprise you.

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Unlike chemotherapy, which involves administering powerful drugs that kill both cancerous and healthy cells (most healthy cells can repair themselves), immunotherapies harness the power of the immune system to help it identify and knock out just the cancerous cells. But just like chemotherapy and radiation, immunotherapy can have side effects, but they tend to look very different than those from the other treatments.

The results have big implications on the way lung cancer is treated by making immunotherapy a part of the standard way the cancer's treated. According to the American Cancer Society, there are about 234,000 new cases of lung cancer each year. Around 80% to 85% of those cases are a type of lung cancer called non-small cell lung cancer, which these trials focused on. Overall, lung cancer is the second-most common cancer next to breast cancer in women and prostate cancer in men.

This is a competitive field. Opdivo, a PD-1 inhibitor which was originally approved in 2014, made $4.9 billion in revenue in 2017, while Yervoy – initially approved in 2011 — made $1.2 billion. Opdivo's approved to treat a number of different forms of cancer, and in later-stage lung cancer, while Yervoy is approved to treat melanoma. Keytruda, which works in a similar way to Opdivo and was approved initially in 2014, made $3.8 billion in revenue in 2017. 

And each company's approach to tackling advanced lung cancer is slightly different. Here's how they stack up. 

Keytruda and chemotherapy

In a phase 3 trial, Merck randomized 616 patients with advanced or metastatic nonsquamous non-small cell lung cancer to either receive a combination Keytruda with chemotherapy (pemetrexed and platinum) or the chemotherapy combined with a placebo drug.

Of the 4o5 patients that were part of the group that received the immunotherapy, the rate of overall survival at the end of 12 months was 69.2%. In the group that received just chemotherapy, that overall survival rate was 49.4%

Progression-free survival — a clinical endpoint that basically means the cancer hasn't grown — was a median of 8.8 months in those who received Keytruda, while those in the chemotherapy group had a median progression-free survival of 4.9 months. The results were not dependent on how much PDL1 — a protein associated with the target Keytruda acts on — was expressed in their body, though those that had more tended to do better. The hazard ratio for death was .49, meaning those who received immunotherapy and chemotherapy were half as likely to die as those who received chemotherapy alone. 

SEE ALSO: America’s top cancer official has a plan to fix one of the biggest limits to finding new cancer treatments

Merck already got FDA approval in May 2017 to treat lung cancer using Keytruda and chemotherapy based on data from a phase 2 study.

Dr. Leena Gandhi, the principal investigator on the trial presented Monday and the director of the thoracic medical oncology program at Perlmutter Cancer Center at NYU Langone Health, also led that phase 2 study. Gandhi said that she didn't change her practice and make immunotherapy part of her standard treatment for lung cancer patients based on those earlier results. That changes now that she has the survival data from the phase 3 trial. 

"It means that we are going to have lung cancer patients living longer and better than they did in the past," Gandhi told Business Insider. 

That could raise the bar for what it takes to treat lung cancer. 

"Our position is that this really does become the floor that any new treatment is going to have to beat," Roy Baynes, Merck's senior vice president of clinical development, told Business Insider.

Combining Opdivo and Yervoy

BMS's trial looked at how its combination of its immunotherapy drugs — Opdivo and Yervoy — compared to chemotherapy in a certain group of lung cancer patients. It's the only company coming out with a strictly immunotherapy-based regimen compared to chemotherapy.

The trial found that the combination managed to keep lung cancer patients' disease with a high amount of tumor mutations from progressing longer than those treated with chemotherapy. The median progression-free survival in the 139 patients treated with the immunotherapy combination was 7.2 months compared to the 160 treated with chemotherapy, whose median was 5.5 months. 

BMS's was the only trial to use a biomarker called tumor mutation burden. The idea is that the more mutations a tumor has, the more likely the immune system will be able to recognize it and go after it. In lung cancer patients who had high TMB (45% of the patients in the trial qualified), the treatment was considered superior to chemotherapy in keeping cancer from progressing.

"This will be a landmark day, because it is the first proof for that and not only that, it is the first proof in a large, randomized first-line lung cancer trial, so the biggest disease in cancer, a first-line indication," David Fabrizio, head of immunotherapy at Foundation Medicine, told Business Insider. BMS uses Foundation Medicine's test to figure out the TMB for each patient. 

Rochealso shared its progression-free survival data at the conference on Monday. According to data released Friday, of the 692 patients that took part in the trial, those that received a combination of the company's cancer immunotherapy Tecentriq with one of its other cancer drugs, Avastin, along with carboplatin and paclitaxe had a median progression-free survival of 8.3 months, while the group in the trial that received Avastin and the chemotherapy without the immunotherapy had a median of about 6.8.

That benefit was the same regardless of how much PD-L1 the patients expressed. Data on overall survival was not included, but in March, Roche said the combination helped people with advanced non-squamous non-small cell lung cancer "live significantly longer" than those who received Avastin, carboplatin and paclitaxel alone. 

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