Symposium 15

Abstract:
Immune checkpoint inhibitors, such as anti-PD-1/PD-L1 and anti-CTLA-4 agents, have substantiated their efficacy as therapeutic modalities for metastatic lung cancers over the past 10 years. The first checkpoint inhibitor, pembrolizumab, obtained FDA approval in 2014 as a second-line treatment in non-small-cell lung cancer (NSCLC). Subsequently, in conjunction with other agents such as nivolumab and atezolizumab, these anti-PD-1/PD-L1 inhibitors expeditiously transitioned to the forefront of initial treatment, markedly altering the landscape of the management for metastatic NSCLC patients. On the other hand, for locally advanced NSCLC, Durvalumab, another anti-PD-L1 agent, has demonstrated a remarkable overall survival advantage in stage III NSCLC following standard concurrent chemoradiation. In 2021, the pivotal phase III trial, Checkmate 816, revealed that a chemoimmunotherapy regimen administered for three cycles prior to surgical intervention in stage II and III NSCLC patients yielded a pathological complete response rate (pCR) of 24.1%, contrasting with the 2.2% pCR rate observed with chemotherapy alone. Subsequently, a substantial increase in disease-free survival (DFS) was ascertained, aligning with expectations. Concurrently, atezolizumab also showed a significant DFS benefit subsequent to standard post-operative chemotherapy. In 2023, multiple perioperative chemoimmunotherapy investigations, entailing the administration of immunotherapy both before and after surgery, collectively elucidated a pCR rate alongside prolonged DFS which faithfully reproduced the prior clinical trials results. Nonetheless, due to the limited follow-up duration, none of the aforementioned studies have thus far demonstrated an overall survival benefit for patients. In summary, the role of immune checkpoint inhibitors across various stages of NSCLC has been unequivocally established. In early-stage lung cancer, immune checkpoint inhibitors manifest a highly promising potential to enhance the curative prospects for resectable lung cancer, marking a paradigm shift in the history of lung cancer therapeutics.