The role of immunotherapy in the treatment of non-small cell lung cancer

Lung cancer is the leading cause of cancer-related mortality in the Czech Republic and worldwide. Of all lung cancer cases at least80 % are non-small-cell lung cancer (NSCLC). For patients with advanced-stage NSCLC, modern platinum doublet chemotherapyresults in a median overall survival (OS) of 10 months. Recently, personalized therapy for patients with tumors with specificmolecular biological characteristics, such as tyrosine kinase inhibitors for tumors with activating EGFR mutations, has resulted inbetter OS outcomes in these biologically selected subgroups. Significant improvement in overall survival (OS) has been achievedin recent years with targeted treatment, but only effective in a small amount of patients. In addition to the remarkable progressmade with targeted drugs, such as EGFR and ALK inhibitors in tumor-bearing control mutations, much hope also resides in immunotherapy.Lung cancer immunotherapy has not been successful in the past. In the last decade, however, a better understandingof the immune system and identification of relevant target antigens has made it possible to test new therapies with promisingresults. The breakthrough treatment in NSCLC immunotherapy represent monoclonal antibodies against the immune responsecheckpoints, especially antibodies to the PD-1 cell death programmed receptor and its ligand PD-L1. The challenge remains toidentify the most effective treatment sequence involving immunotherapy, to understand the mechanisms of resistance of checkpointinhibitors and to identify biomarkers for the optimal benefit from immunotherapy for NSCLC patients.

Keywords: immunotherapy, advanced NSCLC, PD-1, PD-L1