Chemotherapy and/or immune checkpoint inhibitors in NSCLC first-line setting: what is the best approach?

• Published in: Lung cancer management 2020-03, Vol.9 (1)
• Main Authors: Gravara, Luigi Della, Battiloro, Ciro, Cantile, Rosa, Letizia, Antonietta, Vitiello, Fabiana, Montesarchio, Vincenzo, Rocco, Danilo
• Format: Article
• Language: English
• Subjects: Antigens; Biomarkers; CheckMate; chemo-immunotherapy; Chemotherapy; FDA approval; first-line; immune checkpoint Inhibitors; Immunotherapy; IMpower; KEYNOTE; POSEIDON
• ISSN: 1758-1966; 1758-1974
• DOI: 10.2217/lmt-2019-0018

[...]while it enhances the number of CD8+ tumor microenvironment (TME) infiltrating T cells and stimulates the maturation and activity of antigen-presenting cells, it also promotes down-regulation of myeloid-derived suppressor cells (MDSCs) and Tregs production and TME infiltration. [...]taking into account these preclinical and early clinical data, several chemo-immunotherapy combinations have been investigated in clinical settings and thanks to the very promising results achieved, to date, some of these combinations are US FDA and EMA approved and are starting to shape different international clinical guidelines. [...]the experimental arm outclassed the placebo one: median progression-free survival (PFS): 8.8 vs 4.9 months; hazard ratio (HR) for progression of disease (PD) or death: 0.52; with a comparable rate of grade 3-5 treatment-related adverse events (TRAEs) between the two arms: 67.2 vs 65.8%. [...]the experimental arm granted better results than the control one: median PFS: 8.3 vs 6.8 months; HR for PD or death : 0.62; median OS: 19.2 vs 14.7 months; HR for death: 0.78; with a comparable rate of grade 3-4 TRAEs between the two arms: 55.7 vs 47.7 %, respectively. [...]these results seem to suggest a sequential approach in this subset of patients, administering upfront single-agent pembrolizumab followed by post-progression classic standard of care chemotherapy.