Chemotherapy plus single/double immunotherapy in the treatment of non-oncogene addicted advanced non-small cell lung cancer: where do we stand and where are we going?

ABSTRACT

Introduction

Chemo-immunotherapy combinations have revolutionized our treatment algorithm with respect to naïve advanced NSCLC; however, given the great number of developed and approved combinations, the question arises as to which combinations provide the best efficacy and safety.

Areas covered

This review assesses and discusses the available data concerning chemo-immunotherapy combinations in the treatment of naïve advanced NSCLC, as well as presenting the most promising data involving combinations currently under investigation.

Expert opinion

Pembrolizumab-containing chemo-immunotherapy combinations are associated with the most mature data available and presently represent the standard treatment in clinical practice in naïve advanced NSCLC-affected patients. The nivolumab plus ipilimumab plus short-course chemotherapy combination, more recently approved by regulatory agencies, is an appealing alternative, thanks to the reduced rate of grade 3–5 TRAEs and the limited chemotherapy administration. The new chemo-immunotherapy combinations currently under investigation will help us to better identify both the best immune checkpoints to target and the most effective combinations to administer.

KEYWORDS:

• Chemotherapy
• chemo-immunotherapy combinations
• Immunotherapy
• TIGIT
• TIM 3

Article highlights

• Chemo-immunotherapy combinations have revolutionized our treatment algorithm with respect to naïve advanced NSCLC.

• Pembrolizumab-containing chemo-immunotherapy combinations are associated with the most mature data available and presently represent the standard treatment in clinical practice.

• The nivolumab plus ipilimumab plus short-course chemotherapy combination, more recently approved by regulatory agencies, can represent an appealing alternative thanks to the reduced rate of grade 3–5 TRAEs and the limited chemotherapy administration.

• With reference to the several new chemo-immunotherapy combinations currently under investigation, the results coming from their trials will surely help us to reach a better understanding of the combined action of chemotherapy plus immunotherapy and of the role of each ICI in the framework of the tumor microenvironment, globally allowing us to more efficiently choose the most effective treatment for our patients.

Declaration of interest

C Gridelli served at a speaker’s bureau and advisory board and received honoraria from AstraZeneca, Bristol Myers Squibb, Merck Sharp & Dohme and Roche. 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. 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 or other relationships to disclose.

Additional information

Funding

The authors have no funding to report.