Data suggests stopping immunotherapy after two years is reasonable in patients with advanced lung cancer

A new Penn Medicine study finds indefinite immunotherapy is not associated with improved survival in large, retrospective cohort.

Over the past decade, the approval of immune checkpoint inhibitors has revolutionized treatment for patients with advanced lung cancer, helping many live longer lives and improving overall survival for the disease. However, a question remains: How long should a patient with advanced non-small cell lung cancer, who receives immunotherapy as part of their initial treatment, continue with treatment?

A cancer patient holding hands with a relative in consult with a doctor in a hospital bed.
Image: iStock/XiXinXing

A new retrospective cohort study, published in JAMA Oncology, suggests that it’s reasonable to stop immunotherapy treatment at two years as long as their cancer hasn’t progressed. The researchers found no statistically significant difference in overall survival between patients who stopped treatment at two years and those who continued treatment indefinitely.

“We hope this data provides reassurance that stopping treatment at two years is a valid treatment strategy that does not seem to compromise overall survival,” says lead author Lova Sun, an assistant professor of hematology-oncology at the Perelman School of Medicine. “In the absence of definitive prospective data about the duration of therapy—which will take years to accumulate—our goal was to use real-world observational data to provide guidance on this important clinical question.”

The appropriate length of treatment remains an open question because pivotal clinical trials have used different treatment durations, and as therapies have been approved and become widely available, many patients have continued therapy beyond the one to two years tested in clinical trials. The longer a patient continues treatment, the higher the health care costs become—both to the patient and to the health care system—and there is ongoing risk of immune-related side effects.

“Ultimately, the field is still on the leading edge of determining the most appropriate duration for these immunotherapies that have been so effective for patients with advanced lung cancer,” says senior author Charu Aggarwal, the Leslye M. Heisler Associate Professor for Lung Cancer Excellence in Hematology-Oncology at Penn. “This study provides important data that we hope will help patients feel less worried about potential risks of coming off therapy and more confident if they decide to discontinue treatment after two years.”

This story is by Meagan Raeke. Read more at Penn Medicine News.