Traitements de première ligne dans les CBNPC avancés, en l’absence d’addiction oncogénique (incluant le traitement de maintenance et les anti-angiogéniques)

Abstract

First-line treatment of metastatic NSCLC without oncogenic addiction remains based on chemotherapy regimen combining a platinum salt and a third generation cytotoxic drug, with similar results for the different available schedules. The improvement of chemotherapy results has been limited to non-squamous carcinoma, deriving from maintenance strategies mainly based on continuation of pemetrexed as a single agent and on addition of bevacizumab to chemotherapy. The development of immunotherapy in first-line therapy with anti-PD-1 and anti-PD-L1 is changing the first line treatment algorithm of advanced NSCLC. 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-1/PD-L1 to platinum-based chemotherapy are superior to chemotherapy alone could become the 1st line gold-standard even though the issue of their restriction to NSCLC patients of which the tumour expresses no or low PD-L1 expression remains discussed since hyper-progression of poor prognosis are also observed in patients with highly PD-L1 expressing tumours.