Abstract
Immune checkpoint inhibitors (ICIs) are standard treatments for patients with lung cancer. PD-1/PD-L1 or CTLA4 antibodies are chosen as the first-line therapy, contributing to the long-term survival and tolerability. Unlike molecular targeting agents, such as gefitinib, lung cancer patients with a poor performance status (PS) display unsatisfactory clinical improvements after ICI treatment. Several previous reports also demonstrated that the PS is identified as one of the most probable prognostic factors for predicting poor outcomes after ICI treatment. However, first-line pembrolizumab seemed to be effective for lung cancer patients with a PS of 2 if PD-L1 expression was greater than 50%. Currently, the induction of ICIs in patients with lung cancer with a poor PS is controversial. These problems are discussed in this review.
Highlights
Non-Small-Cell Lung Cancer with a Immune checkpoint inhibitors (ICIs), such as programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA4) antibodies, are widely administered to patients with several types of cancers
The results of this study suggest that a progressive disease (PD)-1 blockade is effective in a limited population of non-small-cell lung cancer (NSCLC) patients with PD-L1 ≥ 50%
It remains unclear why obesity improves the efficacy of PD-1 blockades in cancer patients, an in vivo study demonstrated that the frequency of PD-1 on tumor-infiltrating CD8+ T cells was significantly higher in obese mice than in control mice, and a PD-1 blockade was apparently effective in obese mice compared with control mice [28]
Summary
Non-Small-Cell Lung Cancer with a Immune checkpoint inhibitors (ICIs), such as programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA4) antibodies, are widely administered to patients with several types of cancers. It is surprising that long-term survival of more than 5 years was observed in patients with advanced malignant melanoma and metastatic/recurrent non-small-cell lung cancer (NSCLC). Several previous reports demonstrated that PD-1 blockade monotherapy was not effective in such patients [3,4,5]. As a first-line setting, chemotherapeutic regimens, including a PD-1 blockade, are universally established as standard treatment for patients with advanced NSCLC without any driver mutations. Unlike molecular targeting agents, such as gefitinib, advanced or recurrent NSCLC patients with poor PSs displayed unsatisfactory clinical improvements after ICI treatment. The administration of a PD-1 blockade in NSCLC patients with a poor PS remains controversial. These problems are discussed in this review.
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