Biological therapies in lung cancer treatment: using our immune system as an ally to defeat the malignancy

ABSTRACT

Introduction: Biological therapies, with immunotherapy leading the field, have arisen as one of the quickest expanding areas of research for cancer treatment in the last few years. The clear benefits for patients are undeniable, satisfying the long-awaited necessity of a target-specific therapy. However, its full potential remains still unexploited due to a lack of response in a majority of patients and pending reliable biomarkers.

Areas covered: This review provides a summarizing view of the current biological therapies for lung cancer, focusing on immunotherapy – including immune checkpoint inhibitors, adoptive cell therapy and vaccines available in clinical/pre-clinical settings or currently in development. A thorough analysis of the technical and functional differences among all therapies is provided, along with a critical discussion of prospective treatments and potential biomarkers.

Expert opinion: The use of immunotherapy in the treatment of cancer has provided clear benefits for patients. Still, exploitation of the full potential of immune checkpoint inhibitors alone or in combination, or adoptive cell therapies is hampered by, amongst other reasons, the lack of reliable biomarkers and possible adverse immune effects. We postulate that the development of liquid biopsy-based diagnostics will help to overcome these limitations in the near future.

KEYWORDS:

• Lung cancer
• immunotherapy
• anti-PD1/PD-L1
• TILs
• CAR T cells
• monoclonal antibody
• biomarkers

Article highlights

• Recent clinical trials show clear benefit for lung cancer patients treated with immune checkpoint inhibitors alone or in combination settings. However, response rates are still not satisfactory.

• Development of adoptive cell therapy to be applied in lung cancer (EGFR CAR T-cell) is rapidly progressing and showing good results in the preclinical phase.

• Following CIMAvax-EGF, other anti-cancer vaccine approaches are likely to emerge as immunization options for lung cancer patients in the upcoming years.

• Application of blood-based biomarkers for treatment selection and response monitoring should improve patients’ outcomes in the near future.

This box summarizes key points contained in the article.

Acknowledgments

We would like to thank Stephanie Davies for language editing assistance.

Declaration of interest

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

M Filipska and C Pedraz-Valdunciel are pre-doctoral researchers at IGTP, supported by Marie Skłodowska-Curie Innovative Training Networks European Grant (ELBA No.765492). I Chaib and R Rosell are partially supported by a grant from La Caixa Foundation, a Marie Skłodowska-Curie Innovative Training Networks European Grant (ELBA No.765492), an Instituto de Salud Carlos III grant (RESPONSE, PIE16/00011) and a Spanish Association Against Cancer (AECC) grant (PROYE18012ROSE).