Facing the first-line in metastatic non-small-cell lung cancer – Immunotherapy and chemotherapy

Abstract

Over the last few years, the treatment of metastatic non-small-cell lung cancer (NSCLC) has completely changed due to the advent of immunotherapy, which dramatically improved prognosis in patients without any driver alterations. First, three distinct immune checkpoint inhibitors (ICIs), nivolumab, pembrolizumab and atezolizumab, became the standard second- or later-line treatments in both squamous and non-squamous NSCLC; later pembrolizumab replaced first-line chemotherapy in advanced NSCLC characterised by programmed death ligand 1 expression of at least 50%. Based on the significant efficacy and safety results using single-agent immunotherapy, ICIs in combination with other ICIs or chemotherapy, have been largely evaluated. In particular, since 2018, several studies combining ICIs and platinum-based chemotherapy as first-line treatment showed impressive results quickly resulting in a promising new standard of care for the near future.