Checkpoint Inhibitors To Play Major Role in Treatment of NSCLC

A recent study in The Ochsner Journal examined the role of checkpoint inhibition in Non–Small Cell Lung Cancer (NSCLC) treatment.

“The treatment for advanced stage NSCLC has traditionally been centered on platinum-based two-drug combination chemotherapy in patients with an appropriate performance status,” Jonathan Lu, MBBS, of the department of hematology and oncology at the Ochsner Clinic Foundation, and colleagues wrote. “However, immune checkpoint inhibitors are novel therapies that have had success in the treatment of patients who have failed traditional therapies and are now finding a role in first-line treatment under certain situations.”

Dr Lu added that the use of immune checkpoint inhibitors “in NSCLC remains in its infancy, but rapid progress has been made in treating metastatic NSCLC.”

In Dr Lu’s study, he highlighted clinical trials of Opdivo (nivolumab; Bristol-Myers Squibb), an immune checkpoint inhibitor antibody that targets the PD-1 receptor to overcome the immune resistance in cancer, to show that it could have success as a first-line therapy. However, head-to-head trials with chemotherapy prevent the drug from being indicated as a first-line treatment.

“Given the success of [Opdivo] in the second-line setting, the CheckMate-026 trial evaluated [Opdivo] in the first-line setting compared to platinum-based combination chemotherapy,” he wrote. “The study examined 541 patients and showed that [Opdivo] did not improve PFS, with a median of 4.2 months in the [Opdivo] group compared to 5.9 months in the platinum-based combination chemotherapy group. As a result, [Opdivo] remains indicated only in the second-line setting after progression on traditional chemotherapy.”

Dr Lu also noted that Keytruda (pembrolizumab; ) was the first checkpoint inhibitor to gain approval as a first-line therapy. He also emphasized that based on clinical trial data Tecentriq (atezolizumab; Genentech) could be a potential first-line therapy against NSCLC.

“Immunotherapy offers a novel approach to the treatment of advanced NSCLC in the absence of targetable genetic mutations,” Dr Lu wrote. “As time passes, the indications for these novel therapies continue to expand, including more patients and changing the course of disease. Ultimately, the management of NSCLC has undergone revolutionary changes, and as a result, further advances in treatment are anticipated.”

—David Costill

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