Update in Immunotherapy for Advanced Non-Small Cell Lung Cancer: Optimizing Treatment Sequencing and Identifying the Best Choices
by
, , , and
Katia Roque
1,2,3,4
,
Rossana Ruiz
2,5,
Luis Mas
2,3,6,
Daniel Humberto Pozza
7,8,
Marina Vancini
1,
José Antônio Silva Júnior
1
and
Ramon Andrade de Mello
1,9,10,*
1
Discipline of Medical Oncology, Post-Graduation Programme in Medicine, Faculty of Medicine, Nine of July University (UNINOVE), São Paulo 04101-000, Brazil
2
Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Angamos Este Av., 2520, Lima 15023, Peru
3
Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
4
Faculty of Medicine, Universidad Nacional Mayor de San Marcos, Lima 15081, Peru
5
Escuela Profesional de Medicina Humana-Filial Ica, Universidad Privada San Juan Bautista, Ica 15067, Peru
6
Department of Medical Oncology, Oncosalud-AUNA, Av. Guardia Civil 571-San Borja, Lima 15036, Peru
7
Experimental Biology Unit, Department of Biomedicine, Faculty of Medicine of Porto, University of Porto, 4200-319 Porto, Portugal
8
i3S—Institute for Research and Innovation in Health and IBMC, University of Porto, 4200-319 Porto, Portugal
9
Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
10
Department of Oncology, University of Oxford, Oxford OX1 2JD, UK
*
Author to whom correspondence should be addressed.
Cancers 2023, 15(18), 4547; https://doi.org/10.3390/cancers15184547
Submission received: 9 July 2023
/
Revised: 9 September 2023
/
Accepted: 9 September 2023
/
Published: 13 September 2023
(This article belongs to the Section Cancer Therapy)
Simple Summary
Immunotherapy stands as a cornerstone in the treatment of advanced lung cancer patients without an oncogenic driver mutation. This comprehensive review provides an overview of immunotherapy treatment options and offers an algorithm for selecting the most appropriate regimen in various clinical scenarios. Additionally, we delve into practical considerations commonly encountered in clinical settings, as well as the latest advancements in the field.
Abstract
The introduction of immunotherapy has brought about a paradigm shift in the management of advanced non-small cell lung cancer (NSCLC). It has not only significantly improved the prognosis of patients but has also become a cornerstone of treatment, particularly in those without oncogenic driver mutations. Immune checkpoint inhibitors (ICIs) play a crucial role in the treatment of lung cancer and can be classified into two main groups: Anti-cytotoxic T lymphocyte antigen-4 (Anti-CTLA-4) and anti-T-cell receptor programmed cell death-1 or its ligand (Anti-PD-1 and Anti-PD-L1). Certainly, the landscape of approved first line immunotherapeutic approaches has expanded to encompass monotherapy, immunotherapy-exclusive protocols, and combinations with chemotherapy. The complexity of decision-making in this realm arises due to the absence of direct prospective comparisons. However, a thorough analysis of the long-term efficacy and safety data derived from pivotal clinical trials can offer valuable insights into optimizing treatment for different patient subsets. Moreover, ongoing research is investigating emerging biomarkers and innovative therapeutic strategies that could potentially refine the current treatment approach even further. In this comprehensive review, our aim is to highlight the latest advances in immunotherapy for advanced NSCLC, including the mechanisms of action, efficacy, safety profiles, and clinical significance of ICI.
