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Published on: October 10, 2025
Immune Checkpoint Inhibitors in the Management of Lung Cancer
Stefan Zimmermann1, Solange Peters1, Taofeek Owinokoko1
1From the Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland; Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA; and the Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI.
Abstract:
Immune checkpoint inhibitors, specifically PD-1-directed agents, have changed the treatment paradigm of non-small cell lung cancer (NSCLC) and are being actively evaluated in patients with small cell lung cancer. After initial studies demonstrated survival advantage with these agents in patients with recurrent NSCLC, these agents now have demonstrated survival advantage in some patients with early-stage NSCLC. Further evaluation of these agents in combination with chemotherapy regimens and other checkpoint inhibitors is ongoing. Recent data suggest that addition of these agents to chemotherapy may improve survival compared with chemotherapy alone. Promising results have also been observed in patients with recurrent small cell lung cancer. Ongoing studies will define the role of these agents in the management of patients with small cell lung cancer. Tumor PD-L1 assessment has become standard of care since use of frontline pembrolizumab in patients with advanced NSCLC is based on tumor PD-L1 expression. Other biomarkers are being actively evaluated to identify the patients most likely to benefit from these agents. Unique adverse effects are observed with the use of immune checkpoint inhibitors. Knowledge of the adverse effects and their management is crucial in treating patients with lung cancer using immune checkpoint inhibitors.
Insights
Immune checkpoint inhibitors, like PD-1 agents, are transforming lung cancer treatment. These therapies show survival benefits in both early and recurrent non-small cell lung cancer and are being studied for small cell lung cancer.
Area of Science:
- Oncology
- Immunotherapy
Background:
- Immune checkpoint inhibitors (ICIs), particularly PD-1 inhibitors, have revolutionized non-small cell lung cancer (NSCLC) treatment.
- These agents are now being investigated for their efficacy in small cell lung cancer (SCLC).
Purpose of the Study:
- To review the current role and ongoing investigations of PD-1 inhibitors in NSCLC and SCLC.
- To highlight the importance of biomarkers and management of unique adverse effects associated with ICIs.
Main Methods:
- Review of current clinical data and ongoing trials involving PD-1 inhibitors in lung cancer.
- Discussion of biomarker strategies, including PD-L1 expression, for patient selection.
- Overview of the unique adverse events related to ICI therapy.
Main Results:
- PD-1 inhibitors demonstrate survival advantages in recurrent and early-stage NSCLC.
- Combinations of ICIs with chemotherapy show improved survival compared to chemotherapy alone.
- Promising results are emerging for ICIs in recurrent SCLC.
Conclusions:
- PD-1 inhibitors are integral to NSCLC management, with expanding roles in earlier stages and SCLC.
- Tumor PD-L1 expression is a standard biomarker for guiding treatment decisions in advanced NSCLC.
- Understanding and managing ICI-related toxicities is critical for patient care.
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