New data: new options for front-line therapy in NSCLC?

Non-small cell lung cancer (NSCLC) is a deadly disease that still accounts among the most cancer deaths worldwide. Since characteristic symptoms are lacking, the majority of patients is diagnosed in an advanced tumour stage. In recent years, we have learnt a lot about the diversity of NSCLC and the need for different treatment strategies. For example, the identification of selected molecular alterations offers the chance of specific tyrosine kinase inhibitors or antibodies that result on substantially prolonged overall survival. However, only the minority of stage IV patients carry these molecular alterations, while the majority does not benefit from these drugs.Recently, another novel approach, the modulation of the immune system by checkpoint inhibitors, has been developed. For the first time, clinical trials have demonstrated that treatment with various programmed death receptor (PD-1) and PD-ligand (PD-L1) inhibitors can yield into long-term survival for a subset of patients, a phenomenon that has rarely been observed in patients treated only with chemotherapy.1 While monotherapy with PD-1 or PD-L1 inhibitors is generally well tolerated, it also challenges physicians with a wide spectrum of side effects that is very different to those known from chemotherapy or tyrosine kinase inhibitors. Consequently, to date, various PD-1 and one PD-L1 antibodies have been licenced for therapy of pretreated NSCLC. In addition, untreated NSCLC patients with high PD-L1 expression have shown superior progression-free and overall survival for first-line pembrolizumab monotherapy compared with platinum-based chemotherapy.2 Currently, clinical trials evaluate various combinational therapy approaches including chemotherapy and immune modulating agents. One major focus is the increase and early identification of the subset of patients with a long-term control of their cancer disease resulting in long-term survival. As the first of many approaches, data from the phase III IMpower150 study have been released at the European Society of Medical Oncology Immuno Oncology Congress end …