Immunotherapy alone or chemo-immunotherapy as front-line treatment for advanced non-small cell lung cancer

ABSTRACT

Introduction: Immunotherapy, either as monotherapy or in combination with chemotherapy, has demonstrated superior efficacy to chemotherapy alone in the frontline setting. To date, there has been no randomized study comparing immunotherapy alone with chemo-immunotherapy.

Areas Covered: This paper reviews the immunobiological rationale for combining chemotherapy with checkpoint inhibitors as well as the data from recent phase-3 studies to understand the risks and benefits associated with either therapeutic approach for diverse patient populations.

Expert opinion: Frontline pembrolizumab monotherapy remains the treatment of choice for patients with high PD-L1 expression. For those with low PD-L1 expression, pembrolizumab in combination with chemotherapy can be considered.

KEYWORDS:

• Medical oncology
• lung cancer
• immunotherapy
• clinical trials

Article Highlights

• Immune checkpoint inhibitors have changed the treatment landscape for Stage IV non-small cell lung cancer.

• Increasingly, immune checkpoint inhibitors are being incorporated into the first-line treatment paradigm.

• For patients with high PD-L1 expression, defined as a PD-L1 expression of 50% or greater, monotherapy with pembrolizumab is felt to be the current standard of care.

• For patients with less than 50% expression of PD-L1, combination chemo-immunotherapy is becoming the new standard of care for most patients.

• Future directions for research will likely be directed toward optimization of chemotherapy dosing, combination chemo-immunotherapy in patients with EGFR mutations and ALK rearrangements and appropriate biomarkers for better treatment selection.

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Declaration of interest

M Shafique has served on advisory boards of GlaxoSmithKline. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.