Immunothérapie pratique, pratique de l’immunothérapie: de la prise en charge initiale au suivi

Abstract

Immunotherapy is a new therapeutic standard for the management of lung cancers, and is now integrated into the treatment strategies, both as single-agent and in combination with chemotherapy. Several real-life studies have been conducted with nivolumab in advanced non-small cell lung cancer; results confirm both the activity and safety profile of nivolumab in the second- and third-line setting, including for patient populations under-represented in landmark clinical trials. Clinical trial data are also available in patients with poor performance status or co-morbidities.With the long-term effectiveness of immunotherapy, a practical issue is the duration of treatment, because in clinical trials, treatment was interrupted after a pre-specified duration of one or two years depending on studies. Since many patients benefit from immunotherapy in the first- or second-line setting, one issue is the definition of optimal treatment sequences, and whether resuming immunotherapy treatment in the third-line and beyond setting, what is referred as to “rechallenge”; recent data actually support such strategy, particularly in patients who presented with initial prolonged disease control or who discontinuated treatment because of side effects.The current practice of immunotherapy is based both on data from the landmark clinical trials that built the current treatment algorithms, and on real-life evidence from retrospective and prospective cohorts, leading to formalize the appropriation of data for the routine management of patients.© 2019 SPLF. Published by Elsevier Masson SAS. All rights reserved.