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Review
. 2018 May 4:10:1758835918772810.
doi: 10.1177/1758835918772810. eCollection 2018.

Immunotherapy in non-metastatic non-small cell lung cancer: Can the benefits of stage IV therapy be translated into earlier stages?

Griet Deslypere  1 , Dorothée Gullentops  1 , Els Wauters  1 , Johan Vansteenkiste  2
Affiliations
Review

Immunotherapy in non-metastatic non-small cell lung cancer: Can the benefits of stage IV therapy be translated into earlier stages?

Griet Deslypere et al. Ther Adv Med Oncol. .

Abstract

Over the last decade, several steps forward in the treatment of patients with stage IV non-small cell lung cancer (NCSLC) were made. Examples are the use of pemetrexed, pemetrexed maintenance therapy, or bevacizumab for patients with nonsquamous NSCLC. A big leap forward was the use of tyrosine kinase inhibitors in patients selected on the basis of an activating oncogene, such as epidermal growth factor receptor (EGFR) activating mutations or anaplastic lymphoma kinase (ALK) translocations. However, all of these achievements could not be translated into survival benefits when studied in randomized controlled trials in patients with nonmetastatic NSCLC. Aside from chemotherapy and targeted therapy, immunotherapy has become the third pillar in the treatment armamentarium of advanced NSCLC. Antigen-specific immunotherapy (cancer vaccination) has been disappointing in large phase III clinical trials in stages I-III NSCLC. Based on the recent breakthroughs with immune checkpoint inhibitor immunotherapy in metastatic NSCLC, much hope currently rests on the use of this approach in patients with stage I-III NSCLC as well. Here we give a brief overview of how most new therapeutic approaches for advanced NSCLC failed in other stages, and then elaborate on the role of immunotherapy in patients with stage I-III NSCLC.

Keywords: adjuvant therapy; early stage; immune checkpoint inhibitors; locally advanced stage; neoadjuvant therapy; non-small cell lung cancer; review; targeted therapy.

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Conflict of interest statement

Conflict of interest statement: JV: advisory functions with Apotex, AstraZeneca, Boehringer Ingelheim, MSD and Novartis.

Figures

Figure 1.
Figure 1.
TNM clinical stages and 5-year overall survival rates of patients with non-small cell lung cancer (adapted from Goldstraw and colleagues).
Figure 2.
Figure 2.
Ongoing phase III randomized controlled trials of adjuvant immune checkpoint inhibitor immunotherapy in patients with completely resected NSCLC. ACRIN, American College of Radiology Imaging Network; ALK, anaplastic lymphoma kinase; DFS, disease-free survival; ECOG, Eastern Cooperative Oncology Group; EGFR, epidermal growth factor receptor; EORTC, European Organization for Research and Treatment of Cancer; ETOP, European Thoracic Oncology Platform; MSD, Merck Sharp & Dohme; NCI-C, National Cancer Institute Canada; NSCLC, non-small cell lung cancer; OS, overall survival; PD-L1, programmed death receptor 1 ligand; PS, performance status; q2w, every 2 weeks; q3w, every 3 weeks; RO, complete resection.
Figure 3.
Figure 3.
Progression-free survival (PFS) in the intention-to-treat population of the two arms in the PACIFIC study (reprinted with permission from Antonia and colleagues). CI, confidence interval
See this image and copyright information in PMC

References

    1. Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 2016; 11: 39–51. - PubMed
    1. Scagliotti G, Parikh P, Von Pawel J, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced stage non-small cell lung cancer. J Clin Oncol 2008; 26: 3543–3551. - PubMed
    1. Paz-Ares L, De Marinis F, Dediu M, et al. Maintenance therapy with pemetrexed plus best supportive care versus placebo plus best supportive care after induction therapy with cisplatin plus pemetrexed for advanced non-squamous non-small cell lung cancer (PARAMOUNT): a double-blind, phase 3, randomised controlled trial. Lancet Oncol 2012; 13: 247–255. - PubMed
    1. Sandler A, Gray R, Perry MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small cell lung cancer. N Engl J Med 2006; 355: 2542–2550. - PubMed
    1. Mok TS, Wu YL, Thongprasert S, et al. Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med 2009; 361: 947–957. - PubMed

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