Abstract
Lung cancer causes significant morbidity and mortality in China and worldwide. In China, lung cancer accounts for nearly one-fourth of all cancer deaths. Non-small cell lung cancer (NSCLC) is the predominant type of lung cancer, accounting for approximately 80%–85% of all lung cancer cases. Immunotherapy with immune checkpoint inhibitors (ICIs) is revolutionizing the treatment of NSCLC. Immune checkpoint molecules, including PD-1/PD-L1 and CTLA-4, can suppress immune responses by delivering negative signals to T cells. By interfering with these immunosuppressive axes, ICIs unleash antitumor immune responses, ultimately eliminating cancer cells. ICIs have demonstrated promising antitumor efficacy in NSCLC, and mounting evidence supports the use of ICIs in treatment-naïve patients with advanced NSCLC. A comprehensive overview of current and emerging ICIs for the first-line treatment of NSCLC in China will facilitate a better understanding of NSCLC immunotherapy using ICIs and optimize the clinical use of ICIs in previously untreated Chinese patients with NSCLC. Herein, we review the efficacy and safety of currently approved and investigational ICIs as the first-line treatment of NSCLC in China. We also discuss the challenges limiting more widespread use of ICIs and future directions in the first-line treatment of NSCLC using ICIs.
Highlights
Lung cancer is the leading cause of cancer-related death in China, accounting for 23.8% of all cancer deaths according to the GLOBOCAN 2020 epidemiological data [1]
The results demonstrated that, compared with chemotherapy, pembrolizumab monotherapy significantly prolonged overall survival (OS) in patients with locally advanced or metastatic Non-small cell lung cancer (NSCLC), with the greatest treatment effect seen in PDL1-high patients
immune checkpoint inhibitors (ICIs) have revolutionized the treatment of NSCLC and other solid malignancies in China and worldwide
Summary
Lung cancer is the leading cause of cancer-related death in China, accounting for 23.8% of all cancer deaths according to the GLOBOCAN 2020 epidemiological data [1]. Atezolizumab is an anti-PD-L1 monoclonal antibody recently approved by the FDA and the NMPA for the first-line treatment of patients with metastatic, PD-L1 high expression nonsquamous or squamous NSCLC harboring no EGFR mutation or ALK rearrangement This approval was based on the findings of IMpower110 (NCT02409342), an international, randomized, open-label trial comparing the efficacy of atezolizumab to that of platinum-based chemotherapy in chemotherapy-naïve patients with stage IV NSCLC expressing PD-L1 on ≥ 1% of tumor cells (TC ≥ 1%) or tumor-infiltrating immune cells (IC ≥ 1%). A subsequent phase III study (KEYNOTE-189) of patients with metastatic EGFR/ALK wild-type nonsquamous NSCLC has shown that, compared with pemetrexed and platinum-based chemotherapy alone, first-line pembrolizumab plus chemotherapy conferred better OS (median, 22.0 vs 10.7 months; HR, 0.56; 95% CI, 0.45–0.70), 3-year OS rate (31.3 vs 17.4%) and PFS (median, 9.0 vs 4.9 months; HR, 0.48; 95% CI, 0.40–0.58); ORR (48.0% vs 19.4%) was extended by 28.6% in patients who received combination therapy [33].
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