To Stop or Not to Stop: Is It Time to Reevaluate Immunotherapy Duration in Advanced/Metastatic NSCLC?

Area of Science:

• Oncology
• Immunology
• Clinical Trials

Background:

• Immunotherapy, specifically immune checkpoint inhibitors (ICIs), has revolutionized advanced non-small cell lung cancer (NSCLC) treatment.
• Durable survival benefits are observed in a subset of patients, but optimal treatment duration is not well-defined.
• Current practices of 2-year limits or indefinite treatment are based on arbitrary trial endpoints, lacking biological rationale.

Purpose of the Study:

• To review current evidence and ongoing trials addressing the optimal duration of ICI therapy in advanced NSCLC.
• To explore emerging biomarkers for risk stratification and treatment refinement.
• To balance treatment efficacy with cumulative toxicities and financial burden.

Main Methods:

• Review of existing literature and landmark clinical trials.
• Analysis of retrospective study data on treatment discontinuation.
• Discussion of ongoing prospective trials and emerging biomarkers.

Main Results:

• Retrospective data suggest 2-year ICI discontinuation may maintain outcomes.
• Concerns exist regarding balancing efficacy, toxicity, and cost.
• Limited prospective evidence currently guides duration decisions.

Conclusions:

• Optimal ICI treatment duration for advanced NSCLC remains an open question.
• Emerging biomarkers like ctDNA and PET/CT imaging show promise for guiding treatment strategies.
• Further research is needed to establish evidence-based guidelines for ICI therapy duration.