Immune checkpoint inhibitors in first-line therapy of advanced non-small cell lung cancer.

PURPOSE OF REVIEW: Evading immune destruction is a hallmark of cancer. The first therapeutic wave in immunotherapies comprised a series of monoclonal antibodies directed against the immune checkpoint molecules cytotoxic T-lymphocyte-associated protein 4, programmed death 1 (PD-1), and programmed death ligand-1 (PD-L1) revolutionizing the therapeutic landscape of advanced non-small cell lung cancer. They were validated initially as second-line treatment, becoming the new standard of care.

RECENT FINDINGS: Based on immunotherapies efficacy, different strategies are being successfully investigated in first-line treatment, including frontline immune checkpoint inhibitors, and combination with chemotherapy or with other immune checkpoint inhibitors. In accordance with recent results, US Food and Drug Administration approved a checkpoint inhibitor for first-line treatment of metastatic non-small cell lung cancer whose tumors have high PD-L1 expression, and European Medicines Agency approval is expected in early 2017.

SUMMARY: In this review, we summarize the main results of the various strategic clinical development approaches used to date, as well as in ongoing clinical trials.