The role of combination chemo-immunotherapy in advanced non-small cell lung cancer

ABSTRACT

Introduction: Even with the currently recommended chemotherapeutic and immunotherapeutic treatment, the five year survival rate for advanced nonsquamous and squamous NSCLC without oncogenic drivers remains poor. However, several different chemo-immunotherapy combinations are presently being investigated – with favorable results- in order to increase the PFS and OS rates of these patients.

Areas covered: Therefore, this paper aims to discuss the most promising trials investigating chemo-immunotherapy combinations and their present and future impact on advanced NSCLC treatment paradigms.

Expert opinion: First line chemo-immunotherapy combinations are starting to and will certainly revolutionize the current paradigm of metastatic non small cell lung cancer treatment due to their superior performances – both in terms of PFS and OS – when compared to the actual standard of care platinum based chemotherapy. However, these associations are not devoid of problems, in fact, combining immunotherapy with chemotherapy obviously leads to enhanced treatment-related toxicities and to higher discontinuation rates; therefore these treatments should be administered carefully.

KEYWORDS:

• Advanced NSCLC
• chemotherapy
• immunotherapy
• chemo-immunotherapy
• combination therapy
• chemo-immunotherapy combinations
• nivolumab
• pembrolizumab
• atezolizumab

Article highlights

• Chemotherapy and immunotherapy as stand-alone therapies represent the current standard of care for advanced NSCLC

• However, five-year survival rates for these patients are still around 15%

• Chemo-immunotherapy combinations are presently being assessed as a possible new treatment

• Chemo-immunotherapy associations are mainly being investigated as maintenance or as first line therapies

• First line chemo-immunotherapy studies results are very encouraging

• Nivolumab/pembrolizumab/atezolizumab-based first line combinations show favorable PFS and/or OS rates both in nonsquamous and squamous advanced NSCLC

• These combinations, however, present higher toxicity rates when compared to standard platinum-based chemotherapy

• To date, a personalized approach should be adopted in employing first line chemo-immunotherapy combinations, but in five years they will surely be one of the new standards of care, in replacement of platinum-based chemotherapy

Declaration of interest

C Gridelli has received honoraria as an advisory board and speaker bureau member for Astra Zeneca, Bristol Myers Squibb, Merck and Roche. The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.