Effect of interleukin-1β inhibition with canakinumab on incident lung cancer in patients with atherosclerosis: exploratory results from a randomised, double-blind, placebo-controlled trial

This RCT (CANTOS; n=10,061) reports that the incident rate of cancer mortality (co-primary endpoint) was statistically significantly lower only for the canakinumab 300mg group compared to placebo (0.31 and 0.64 per 100 person-years respectively; HR 0.49; p=0.0009).

Canakinumab is a therapeutic monoclonal antibody targeting interleukin-1β. The trial randomly assigned patients with a previous myocardial infarction and an elevated level of high-sensitivity C-reactive protein to receive one of three doses of canakinumab (50-mg, 150-mg or 300-mg) or placebo. As compared with placebo, canakinumab reduced the high-sensitivity C-reactive protein level from baseline in a dose-dependent fashion by 3 months and sustained it throughout the dosing period,

 

Fatal infections or sepsis were significantly more common in the canakinumab groups than in the placebo group. All-cause mortality did not differ significantly between the canakinumab and placebo groups (HR 0.94 [95% CI 0.83–1.06]; p=0.31).

 

In a related editorial, the author notes that the findings are preliminary, and therefore should be interpreted with caution. Considering the population included in the trial (see separate report of trial investigating canakinumab for coronary artery diseaase – New England Journal of Medicine 27 Aug 2017), the author questions whether this study implies that only patients with pre-existing atherosclerosis may benefit. The author concludes that although the findings from this study are unlikely to change the management of lung cancer, it does shed light on the role of interleukin-1β in lung cancer, and further more refined studies need to be conducted.