Current status of immune checkpoint inhibition in early-stage NSCLC

J. Vansteenkiste*, E. Wauters, B. Reymen, C. J. Ackermann, S. Peters, D. De Ruysscher

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

47 Citations (Web of Science)

Abstract

Immune checkpoint inhibition (ICI) immunotherapy has revolutionized the approach to metastatic non-small-cell lung cancer (NSCLC). In particular, antibodies blocking the inhibitory immune checkpoints programmed death 1 (PD-1) and its ligand (PD-L1) are associated with higher response rates, improved overall survival and better tolerability as compared with conventional cytotoxic chemotherapy. Recently, ICI has moved from the second-line to the first-line setting for many patients with non-oncogene-addicted NSCLC, either alone or in combination with chemotherapy. The next logical step is to examine this therapy in patients with non-metastatic NSCLC to improve long-term overall survival and cure rates. For patients with unresectable stage III NSCLC, ICI with durvalumab after concurrent chemoradiotherapy has brought a major improvement in 2-year progression-free and overall survival, which holds promise for an improved cure rate. As the relapse pattern in patients with completely resected early-stage NSCLC is predominantly systemic, high expectations rest on the integration of ICI therapy in their treatment approach. A large number of studies with adjuvant or neo-adjuvant ICI are ongoing and will be discussed here. The advent of stereotactic ablative radiotherapy has brought a valid alternative treatment of patients unfit for or not willing to undergo surgery. Data on combining systemic therapy and stereotactic ablative radiotherapy are virtually non-existent, but there is a strong biological rationale to combine radiotherapy and ICI therapy. Early findings in small feasibility studies are promising and now need to be explored in well-designed phase III trials.

Original languageEnglish
Pages (from-to)1244-1253
Number of pages10
JournalAnnals of Oncology
Volume30
Issue number8
DOIs
Publication statusPublished - Aug 2019

Keywords

  • immunotherapy
  • non-small-cell lung cancer
  • early stage
  • clinical trials
  • CELL-LUNG-CANCER
  • STEREOTACTIC ABLATIVE RADIOTHERAPY
  • TUMOR-REGRESSION
  • PHASE-II
  • RADIATION
  • IMMUNOTHERAPY
  • CHEMOTHERAPY
  • BLOCKADE
  • IRRADIATION
  • IPILIMUMAB

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