Immunotherapy – new perspective in lung cancer

Abstract

Lung carcinoma is associated with a high mortality worldwide, being the leading cause of cancer death. It is mainly classified into squamous non-small cell lung cancer (NSCLC), non-squamous NSCLC, and small cell lung cancer. However, such malignancy has been increasingly subdivided into histological and molecular subtypes to guide treatment. Therapies can be used in adjuvant and palliative settings. Regarding immunotherapy, it has been widely tested in both first or subsequent palliative lines. In this sense, drugs such as pembrolizumab, nivolumab, atezolizumab, ipilimumab, avelumab, and durvalumab have been assessed in large studies. Some of these trials have also studied these medicines in adjuvant and in maintenance therapy. In recent years, advances in immunotherapy have raised the hope that the unfavorable prognosis observed in several affected individuals can be changed. Immunotherapy has increased the overall survival in squamous NSCLC, non-squamous NSCLC, and small cell lung cancer. However, it has added to the oncology practice some side effects that are unusual in standard chemotherapy and require special clinical support. In order to show how immunotherapy is being applied in the treatment of lung carcinoma, we reviewed the main studies in adjuvant and palliative scenarios. What is the better scheme? What is the better combination? What is the better dose? When should we use immunotherapy? Does programmed cell death ligand 1 expression significantly interfere in immunotherapy efficiency? Some of these questions have already been answered, while others require more investigations.

Keywords: Lung cancer, Treatment, Immunotherapy, Squamous non-small cell lung cancer, Non-squamous non-small cell lung cancer, Small cell lung cancer

Core tip: Immunotherapy has represented a new hope in the treatment of lung cancer. Improvements in global survival curves in metastatic disease and in local advanced disease have been observed with that therapeutic modality. However, some side effects that are unusual in standard chemotherapy have been frequently observed in immunotherapy, and they require special clinical support. This review aims to discuss some aspects regarding immunotherapy in non-small cell lung cancer and the perspectives about the use of this treatment in the adjuvant scenario and in small cell lung cancer.