Immuno-Oncology—The New Paradigm of Lung Cancer Treatment

Abstract

Systemic therapy is an essential part of treatment for all patients with small-cell lung cancer (sclc) and for most patients with non-small-cell lung cancer (nsclc). Standards of care have evolved dramatically since 2009, especially in the setting of incurable or advanced nsclc. Part of that evolution has been the incorporation of immuno-oncology drugs, especially immune checkpoint inhibitors (icis) into multiple therapeutic scenarios.
 In the present review, we discuss the role of the immune system in lung cancer and the previous failures of immunotherapy for patients with lung cancer. We then provide an overview of the existing evidence for the use of icis in patients with advanced nsclc that is either treatment-naïve or pretreated, for consolidative treatment after chemoradiotherapy in stage iii nsclc, and for palliative therapy in patients with sclc. Finally, we discuss duration of treatment, special populations, and the future of immuno-oncology for patients with lung cancer. Overall, we provide an evidence-based snapshot of immuno-oncology agents in the treatment of lung cancer up to early 2019.

Lung Adenocarcinoma Tumor Origin: A Guide for Personalized Medicine

“…Comprehensive approaches revealed that the LUAD immune landscape is highly heterogeneous between and within tumors, and exerts a strong selection pressure in early-stage LUAD, producing multiple routes to immune evasion [ 85 ]. Lung cancer cells escape from immunosurveillance by reducing antigen presentation, secreting immune-inhibitory cytokines, upregulating immune checkpoints and stimulating immunosuppressive cell subsets [ 86 ]. The analysis of the repertoire of immune infiltrating cells has shown that compared to normal adjacent tissue, NSCLC elicits a robust immune response with an increase in T cell infiltration, particularly regulatory T cells (Tregs) [ 87 ].…”

Granzyme B for predicting the durable clinical benefit of anti-PD-1/PD-L1 immunotherapy in patients with non-small cell lung cancer

“…These patients thus experience unsatisfactory clinical outcomes with limited cytotoxic chemotherapy efficacy. Programmed cell death (PD)-1/PD ligand (PD-L1) inhibitors have recently demonstrated antitumor effects in advanced and metastatic non-small cell lung cancer (NSCLC) patients and have therefore been approved by the United States Food and Drug Administration as standard therapy (2). The tumor proportion score (TPS) of PD-L1 has been used as a predictive marker for immunotherapeutic agents (3)(4)(5).…”

First-Line Nivolumab Plus Ipilimumab Versus Chemotherapy in Advanced NSCLC With 1% or Greater Tumor PD-L1 Expression: Patient-Reported Outcomes From CheckMate 227 Part 1

“…[1][2][3][4] Immunotherapy increases the potential for long-term disease control and survival, but it may require long-term treatment. 5,6 Assessment of health-related quality of life (HRQoL), especially given the potential for adverse events (AEs), is therefore of paramount importance in patients with lung cancer. Patient-reported outcomes (PROs) capture patient perspectives on disease and treatment burden and their impact on HRQoL.…”