Traitements systémiques de première ligne dans les CBNPC avancés en l’absence d’addiction oncogénique: Frontline systemic treatment of advanced NSCLC without oncogenic addiction

Abstract

AbstractFirst-line treatment of metastatic NSCLC without oncogenic addiction was 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 has changed 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(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 might reduce the risk of early disease progression in comparison with pembrolizumab when PD-L1 ≥50%. The room for anti-CTLA-4 + anti-PD(L)-1 combinations remains to be established.© 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.