Immuntherapie des nichtkleinzelligen Lungenkarzinoms (NSCLC)

Abstract

Within a few years the introduction of immune checkpoint inhibitors (ICI) fundamentally changed the treatment landscape of patients with metastatic non-small cell lung cancer (NSCLC) and improved survival for arelevant proportion of patients. Immune monotherapies are highly efficient in cancers showing aPD-L1 overexpression ≥ 50% of tumor cells, all others with alower level and independent from the PD-L1 expression can be treated with various treatment combinations. In a curative setting all PD-L1 positive patients (≥ 1%) who underwent chemoradiotherapy to reduce disease relapse and subsequently to improve survival should undergo an ICI maintenance treatment. Furthermore, positive results from phase III studies are also available for adjuvant treatment of patients with resectable NSCLC, whereby an EMA approval is currently pending. The treatment with ICIs has given rise to anew class of immune-mediated adverse side effects, which occur in approximately one third of the patients and range from easily substituted endocrinopathies to life-threatening organ toxicity. An anticipatory monitoring as well as interdisciplinary treatment are therefore the keys to avoiding progression of higher grade potentially fatal toxicities.