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Current and future biomarkers for outcomes with immunotherapy in non-small cell lung cancer
Boris Duchemann1,2,3, Jordi Remon4, Marie Naigeon1,2
1Gustave Roussy Cancer Campus, Laboratory of Immunomonitoring in Oncology, CNRS-UMS 3655 and INSERM-US23, Villejuif, France.
Abstract:
Immune checkpoint inhibitors (ICI) have been validated as an effective new treatment strategy in several tumoral types including lung cancer. This remarkable shift in the therapeutic paradigm is in large part due to the duration of responses and long-term survival seen with ICI. However, despite this, the majority of cancer patients do not experience benefit from ICI. Even among patients who initially respond to ICI, disease progression may ultimately occur. Moreover, in some patients, these drugs may be associated with new patterns of progression such as pseudo-progression and hyper-progressive disease, and different toxicity profiles with immune-related adverse events. Therefore, the identification of predictive biomarkers may help to select those patients most likely to obtain a true benefit from these drugs, and avoid exposure to potential toxicity in patients who will not obtain clinical benefit, while also reducing the economic impact. In this review, we summarize current and promising potential predictive biomarkers of ICI in patients with non-small cell lung cancer (NSCLC), as well as pitfalls encountered with their use and areas of focus to optimize their routine clinical implementation.
Insights
Immune checkpoint inhibitors (ICI) show promise for lung cancer, but many patients don't benefit. Identifying predictive biomarkers is crucial for selecting patients likely to gain true benefit and avoid toxicity.
Area of Science:
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitors (ICI) represent a significant advancement in cancer therapy, particularly for non-small cell lung cancer (NSCLC).
- While ICI offer durable responses and long-term survival for some patients, a majority do not experience clinical benefit.
- Furthermore, initial responders may eventually progress, and some patients exhibit unique progression patterns or immune-related adverse events.
Purpose of the Study:
- To review current and emerging predictive biomarkers for ICI efficacy in NSCLC.
- To discuss challenges in biomarker implementation and suggest optimization strategies for clinical practice.
Main Methods:
- Literature review of studies on predictive biomarkers for ICI in NSCLC.
- Analysis of biomarker performance, clinical utility, and implementation hurdles.
Main Results:
- Several biomarkers are under investigation for predicting response to ICI in NSCLC.
- Challenges include biomarker variability, resistance mechanisms, and distinguishing true progression from pseudo-progression.
- Optimizing biomarker use requires addressing these pitfalls for improved patient selection.
Conclusions:
- Predictive biomarkers are essential for personalizing ICI therapy in NSCLC.
- Further research and standardization are needed to enhance the clinical utility of these biomarkers.
- Effective biomarker strategies can improve patient outcomes and reduce healthcare costs.
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