Cancer is not without medicine, non-small cell lung cancer immunotherapy drugs

Non-small cell lung cancer (NSCLC) as a common type of lung cancer, due to the discovery of most of the time has been in the late stage, more lost the opportunity of surgery, so drug treatment of NSCLC is still the main treatment. With the advent of immunotherapy, it has brought a major breakthrough in the treatment of NSCLC, and also brought a new opportunity to improve the survival rate of patients with advanced NSCLC.
According to the data, a number of studies have shown that immune combination therapy can bring significant clinical efficacy for patients with various types of advanced NSCLC. Checkpoint inhibitors based on programmed death receptor 1(PD-1), programmed death ligand-L1 (PD-L1) and cytotoxic T lymphocyte-associated antigen 4(CTLA-4) inhibitors have become the focus of research in the treatment of advanced NSCLC.
At present, immune checkpoint inhibitors (ICI) efficacy predictors in the study of the hottest is PD-1 and PD-L1, of which immunohistochemical detection of PD-L1 expression is the most widely used [2]. Drugs currently approved for the treatment of lung cancer include nivolumab, pembrolizumab, carellizumab, atezumab, etc. This article will tell you about these drugs.
01
Nivolumab
The Chinese Anti-Cancer Association's Clinical Oncology Collaboration Committee (CSCO) and the National Comprehensive Cancer Network (NCCN) guidelines have recommend nivolumab for second-line treatment of non-squamous NSCLC and are used as Class IA evidence. The Keynote-024 study found that patients with PD-L1 expression> 50% benefited from immunotherapy; while the CheckMate026 study found that the efficacy of patients with PD-L1 expression ≥ 50% was not related to nivolumab treatment in data analysis [2]. At the World Lung Cancer Conference (WCLC), Professor ALFREDOADDEO pointed out that PD-L1 still has limitations as a biomarker for immunotherapy. Two studies published at the conference analyzed the expression level of PD-L1. It was found that nivolumab group did not show better OS and PFS than docetaxel group, but nivolumab group had more patients with PD-L1 expression ≥ 1%, so nivolumab can be used for squamous cell carcinoma without considering PD-L1 expression, dako28-8 was recommend to test for PD-L1 expression at the time of subsequent approval to screen for more beneficial patients.
02
Pembrolizumab
In a KEYNOTE-024 study, the efficacy and safety of pembrolizumab monotherapy in patients with advanced non-small cell lung cancer without EGFR/ALK abnormalities was significantly higher than that of chemotherapy in patients with non-small cell lung cancer with high PD-L1 expression. In the CheckMate 078 and 057 trials, compared with docetaxel, nivolumab significantly improved patient survival, and the incidence of adverse reactions (AE) was significantly reduced. In patients with low PD-L1 expression, there was also a significant benefit [3].
03
Carrilizumab
In WCLC, Professor Wu Yilong reported that the study of karelizumab in advanced NSCLC population PD-L1 different expression levels compared with the historical data of second-line chemotherapy, karelizumab can improve ORR, PFS and OS regardless of PD-L1 expression level. Among them, patients with higher expression of PD-L1 benefit more from carellizumab. The benefit of patients with PD-L1 expression ≥ 25% is comparable to that of first-line dual-drug chemotherapy in advanced NSCLC. [2]
04
Carrilizumab
In the 2019CSCO and NCCN guidelines, atezolizumab is used as a recommend for the treatment of advanced NSCLC (Class IA evidence), and the FDA also approves atezolizumab as a treatment for NSCLC [2]. According to the POPLAR study, staining of SP42 antibodies PD-L1 by immune cells and tumor cells showed a benefit in the atezolizumab group and increased with increased PD-L1 expression. Studies have analyzed the efficacy of atezolizumab on PD-L1 expression groups or related to PD-L1 expression, and suggested that PD-L1 expression is not required for second-line treatment of NSCLC, and SP42 antibody detection can be used as a supplementary detection factor.
In the same year, a IMpower110 study published at the European Society of Oncology (ESMO) Conference showed that atezolizumab significantly improved the median OS and PFS of primary patients with stage IV NSCLC with PD-L1 ≥ 50%. In addition, it is suggested that IMpow-er131 studies have found that the application of atezolizumab in the first-line treatment of advanced squamous NSCLC only benefits OS in the PD-L1-expressing population [2].
Conclusion
With the continuous development of modern medical technology, after the concept of tumor is a chronic disease was put forward, in the treatment of tumor patients, began to pay more attention to the quality of their life, choose better tolerance, low toxicity, efficient methods to treat cancer patients. It is believed that with the development of the times, more therapies will be used in the field of cancer treatment.
References
[1] Guo Guangran, Zhang Lanjun. Immune microenvironment and immunotherapy of non-small cell lung cancer [J]. China Clinical New Medicine, 2022.
[2] Shi Yuan-chao, Guan Quan-lin. Research progress in predicting the efficacy of immunotherapy for non-small cell lung cancer [J]. Modern Oncology Medicine, 2022, 30(2):5.
[3] Bud, Wang Ronglin, Su Haichuan. Research progress of immune checkpoint inhibitors in the treatment of non-small cell lung cancer [J]. China Medical Herald, 2022, 19(5):5.
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