Immunotherapy in non-small cell lung cancer: a review of the evidence

This study reviewed the use of immunotherapy in non-small cell lung cancer (NSCLC).  

Immunotherapy is a relatively new treatment strategy for cancer. It is particularly important in non-small cell lung cancer (NSCLC). Many patients with NSCLC are diagnosed at an advanced stage. One promising immunotherapy is immune checkpoint inhibitor (ICI) drugs. ICIs target specific proteins involved in the immune system response to cancer cells. One common target of ICIs is the PD-1/PD-L1 pathway. PD-L1 is a protein that binds to its receptor PD-1. Cancer cells ‘hijack’ this pathway so they can grow undetected by the immune system. ICIs block this pathway allowing immune cells to detect and kill cancer cells.

PD-1/PD-L1 inhibitors are promising in advanced cancer. It is still unclear how effective ICIs are in different NSCLC tumors. The safety of ICIs and other immunotherapy drugs are under constant review as more patients are treated with these drugs. 

PD-L1 expression testing is the first step in deciding on immunotherapy. PD-L1 expression of 50% or more would suggest that pembrolizumab (Keytruda) should be used. This may or may not be used in combination with chemotherapy (CT).

For patients with less than 50% PD-L1 expression, a combination of pembrolizumab and CT drugs. In this group of patients, CT drugs used depend on the type of cancer (squamous or non-squamous NSCLC). In non-squamous cell carcinoma, pembrolizumab is combined with carboplatin (Paraplatin)/pemetrexed(Alimta). In those who cannot undergo pemetrexed, the recommended regimen contains carboplatin, paclitaxel (Taxol), bevacizumab (Avastin), and atezolizumab (Tecentriq). In squamous cell carcinoma, the recommended regimen includes pembrolizumab/carboplatin with either paclitaxel or nab-paclitaxel (Abraxane).

Toxicity with ICI drugs is usually low-grade in severity. The rate of high-grade toxicities is approximately 14.26%. The most common side effect of ICIs is fatigue. Some of the high-grade AEs are inflammation in the lungs and colon and skin rashes.

This study reviewed the use of immunotherapy in non-small cell lung cancer.  

This study reviewed recent guidelines. These are based on medical evidence that is constantly being updated. Choosing immunotherapy will depend on the best evidence available. Patient history can also influence the choice of immunotherapy.