Title:Anti PD-1 and PDL-1 Immunotherapy in the Treatment of Advanced Non- Small Cell Lung Cancer (NSCLC): A Review on Toxicity Profile and its Management
Volume: 11
Issue: 1
Author(s): Assunta Sgambato, Francesca Casaluce, Paola C. Sacco, Giovanni Palazzolo, Paolo Maione, Antonio Rossi, Fortunato Ciardiello and Cesare Gridelli
Affiliation:
Keywords:
immune-related adverse events, immunotherapy, management toxicities, nivolumab, PD-1 inhibitors, PD-L1
inhibitors, pembrolizumab.
Abstract: The better understanding of immunology and antitumor immune responses have prompted
the development of novel immunotherapy agents like PD-1 checkpoint inhibitors (anti-PD-1 and anti-
PDL-1 antibodies) that improve the capacity of the immune system to acknowledge and delete tumors,
including lung cancer. Currently, two anti-PD-1 (nivolumab and pembrolizumab) and one anti- PD-L1
(MPDL-3280A) agents are in advanced stages of development in advanced or metastatic non-small cell lung cancer
(NSCLC). Among these, nivolumab demonstrated a survival benefit versus docetaxel in refractory squamous NSCLC,
reporting 41% reduction in risk of death (median overall survival: 9.2 versus 6.0 months; objective response rate: 20%
versus 9%), and better safety profile than standard-of-care chemotherapy (grade 3-4 adverse events: 7% versus 55%).
However, the enhancement of immune response to cancer targeting specific immune regulatory checkpoints is associated
with a toxicity profile different from that related to traditional chemotherapeutic agents and molecularly targeted
therapies. The success of immunotherapy is related to ongoing evaluation/identification and treatment of these immunerelated
side effects. Herein, first clinical results of PD-1 agents in lung cancer are reviewed, focusing on toxicity profile
and its management.
