title: Immune Checkpoint Inhibitors in Non-Small Cell Lung Cancer.
abstract: Historically, lung cancer was long considered a poorly immunogenic malignancy. In recent years, however, immune checkpoint inhibitors have emerged as promising therapeutic agents in non-small cell lung cancer (NSCLC). To date, the best characterized and most therapeutically relevant immune checkpoints have been cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and the programmed cell death protein-1 (PD-1) pathway. In early studies, PD-1/programmed cell death ligand-1 (PD-L1) inhibitors demonstrated promising antitumor activity and durable clinical responses in a subset of patients. Based on these encouraging results, multiple different PD-1/PD-L1 inhibitors have entered clinical development, and two agents (nivolumab and pembrolizumab) have gained regulatory approval in the United States for the treatment of NSCLC. In several large, randomized studies, PD-1/PD-L1 inhibitors have produced significant improvements in overall survival compared with single-agent docetaxel delivered in the second-line setting, effectively establishing a new standard of care in NSCLC. In the present report, we provide an overview of the rationale for checkpoint inhibitors in lung cancer, recent clinical trial data, and the need for predictive biomarkers.
  
  
  
  2017;22:81-88 IMPLICATIONS FOR PRACTICE: Strategies targeting negative regulators (i.e., checkpoints) of the immune system have demonstrated significant antitumor activity across a range of solid tumors. In non-small cell lung cancer (NSCLC), programmed cell death protein-1 (PD-1) pathway inhibitors have entered routine clinical use because of the results from recent randomized studies demonstrating superiority against single-agent chemotherapy in previously treated patients. The present report provides an overview of immune checkpoint inhibitors in lung cancer for the practicing clinician, focusing on the rationale for immunotherapy, recent clinical trial data, and future directions.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Herzberg
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Meghan J
authors.initials: MJ
authors.lastname: Campo
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA jgainor@partners.org.
authors.forename: Justin F
authors.initials: JF
authors.lastname: Gainor
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D060890:B7-H1 Antigen / Q000037:antagonists & inhibitors / Q000235:genetics* / Q000276:immunology; D014408:Biomarkers, Tumor / Q000235:genetics / Q000276:immunology; D060908:CTLA-4 Antigen / Q000037:antagonists & inhibitors / Q000235:genetics / Q000276:immunology; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology; D002986:Clinical Trials as Topic; D000077143:Docetaxel; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects; D000077594:Nivolumab; D061026:Programmed Cell Death 1 Receptor / Q000037:antagonists & inhibitors / Q000235:genetics* / Q000276:immunology; D015398:Signal Transduction / Q000187:drug effects; D043823:Taxoids / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D060890:B7-H1 Antigen; D014408:Biomarkers, Tumor; D060908:CTLA-4 Antigen; C556706:CTLA4 protein, human; C105992:PDCD1 protein, human; D061026:Programmed Cell Death 1 Receptor; D043823:Taxoids; D000077143:Docetaxel; D000077594:Nivolumab; C582435:pembrolizumab
keywords: Checkpoint inhibition; Cytotoxic T‐lymphocyte‐associated antigen 4; Immune therapy; Lung cancer; Non‐small cell lung cancer; Programmed cell death protein‐1 inhibitors