title: Successes and failures: what did we learn from recent first-line treatment immunotherapy trials in non-small cell lung cancer?
abstract: The immune checkpoint inhibitors have significantly modified the therapeutic landscape of advanced non-small cell lung cancer in second-line and, more recently, first-line settings. Because of the superior outcome with pembrolizumab as an upfront strategy, PD-L1 status should now be considered a new reflex biomarker for guiding first-line treatment in patients with advanced non-small cell lung cancer. Improved responses have also been reported with the combination of immune checkpoint inhibitors and chemotherapy as the first-line treatment; however, this strategy has not yet been validated by phase III trial data and its interplay with PD-L1 status still requires clarification.In this manuscript we review the contradictory results of recent phase III trials with immune checkpoint inhibitors in the first-line setting, the potential reasons for discrepancies, and some of the remaining open questions related to the positioning of immune checkpoint inhibitors in the first-line setting of non-small cell lung cancer.
authors.affiliation: Cancer Medicine Department, Gustave Roussy, Villejuif, France.|Medical Oncology Department, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Remon
authors.affiliation: Cancer Medicine Department, Gustave Roussy, Villejuif, France.|University Paris-Sud, Orsay, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Besse
authors.affiliation: University Paris-Sud, Orsay, France. jean-charles.soria@gustaveroussy.fr.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Soria
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D017326:Clinical Trials, Phase III as Topic; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D008175:Lung Neoplasms / Q000188:drug therapy*; D000077594:Nivolumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000077594:Nivolumab; C582435:pembrolizumab
keywords: First-line; Immunotherapy; Nivolumab; Non-small cell lung cancer; PD-1; PD-L1; Pembrolizumab