[Immunotherapy for non-small cell lung cancer (NSCLC)]

Area of Science:

• Oncology
• Immunotherapy
• Thoracic Surgery

Background:

• Immune checkpoint inhibitors (ICIs) have revolutionized metastatic non-small cell lung cancer (NSCLC) treatment.
• ICIs offer survival benefits, particularly in patients with PD-L1 overexpression (≥50%).
• Combinatorial therapies are used for lower PD-L1 expression levels or PD-L1 independent cases.

Purpose of the Study:

• To review the impact of ICIs on NSCLC treatment.
• To highlight the role of ICIs in curative and adjuvant settings.
• To emphasize the importance of managing immune-mediated adverse events (irAEs).

Main Methods:

• Review of current clinical practices and phase III study outcomes for ICI therapy in NSCLC.
• Analysis of efficacy based on PD-L1 expression levels.
• Discussion of irAEs and their management strategies.

Main Results:

• ICIs significantly improve survival in a subset of metastatic NSCLC patients.
• ICI maintenance treatment is recommended for PD-L1 positive (≥1%) patients post-chemoradiotherapy in a curative setting.
• Adjuvant ICI treatment shows promise in resectable NSCLC, pending regulatory approval.
• Approximately one-third of patients experience irAEs, ranging from mild endocrinopathies to severe organ toxicity.

Conclusions:

• ICIs represent a paradigm shift in NSCLC management, offering improved survival across various stages.
• Proactive monitoring and multidisciplinary management are essential to mitigate the risks of potentially severe irAEs.
• The integration of ICIs in both metastatic and early-stage NSCLC underscores their broad therapeutic potential.