Editorial: Updates on combination therapy for lung cancer volume II

Abstract

Editorial on the Research Topic Updates on combination therapy for lung cancer volume IILung cancer is still one of the leading causes of death, representing the most common cancer in both sexes, with over 2.21 million new cases diagnosed yearly (1). The prognosis of lung neoplasms is often poor due to the late diagnosis, which leaves space only for palliative treatment, and due to the molecular and histological heterogeneity of the disease (2).Despite such a dismal background, several advancements have occurred during the last decade. On one hand, the advent of an entirely new class of drugs, the immune-checkpoint inhibitors (ICIs)-capable of tackling tumor cells and unleashing the killing mechanisms of a patient's immune system, has radically improved the survival rates (3). On the other hand, a wider molecular characterization of lung cancer cells and their ability to interact with their surrounding has led to the development of targeted agents and new treatment strategies. The scientific community is constantly striving to identify new molecular pathways to exploit using new anti-cancer agents. However, as a direct consequence of this decade of improvement in lung cancer care, we are facing a new challenge: the need to build the best treatment sequence for each patient, integrating different therapies that, over time, have all proved to be effective.This Research Topic encompasses several articles that address both these crucial challenges. With regards to the "treatment integration" issue, the works of Garon et al. and Yang et al. deal with the role of anti-angiogenic drugs. Angiogenesis plays an important role not only in tumor growth, invasion, and metastasis but also in the acquired resistance to immunotherapy (4). In fact, the Vascular Endothelial Growth Factor (VEGF) is able to exert an immunosuppressive effect on the tumor microenvironment, stimulating the recruitment of immunosuppressive cells and blocking the antigen-presenting process by inhibiting dendritic cell maturation (5). Anti-angiogenic agents proved their efficacy in lung cancer care in a pre-immunotherapy scenario; the advent of ICIs in the first-line setting has created a certain degree of doubt regarding their true impact when administered at disease progression for immunotherapy. In their systematic review, Garon et al. collected all the available evidence on the efficacy and safety of ramucirumab plus docetaxel regimen in an ICI pretreated and in an ICI-naïve group of patients, respectively (Garon et al.