Première ligne des CBNPC avancés sans addiction oncogénique : quel traitement pour quel patient ?: Frontline treatment of advanced NSCLC without oncogenic addiction: which treatment for which patient?

Abstract

The development of immunotherapy in first-line therapy of advanced NSCLC has changed the treatment algorithm which revolves around the blockade of PD-1 - PD-L1 axis. The anti-PD-1 pembrolizumab clearly improves the overall survival in NSCLC with PD-L1 expression in greater than 50% of tumour cells, comparatively to cytotoxic chemotherapy. Combinations of anti-PD(L)-1 to platinum-based chemotherapy are superior to chemotherapy alone, independently of PD-L1 level of expression. They represent the 1st line gold-standard when PD-L1 is expressed in less than 50% of tumour cells and reduce the risk of early disease progression in comparison with pembrolizumab as a single agent when PD-L1 ≥50%, without evidence of an impact on long term survival. The room for ipilimumab-nivolumab in combination with two courses of induction chemotherapy remains to be established. Ipilimumab might increase the proportion of patients deriving a long term benefit from immunotherapy in case of PD-L1 negative or low tumours. Today, making a treatment decision in clinical practice remains based upon PD-L1 level of expression and patient clinical profile, especially in terms of tumour burden and aggressiveness.© 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.