The role of immune checkpoint inhibitors in advanced non-small cell lung cancer

Introduction: Cancer immunotherapy represents a major therapeutic breakthrough. Immune checkpoint inhibitors alone or in the context of a combination are considered the new standard of care in advanced non-small cell lung cancer (NSCLC). Areas covered: This review explains the biologic rationale behind the implementation of immune checkpoint inhibitors for the therapy of advanced NSCLC. It provides a detailed description of the clinical trials that have studied the various agents now in use and the results that lead to the currently approved indications. It also explores the area of established and developing biomarkers, and the trends of combining immunotherapy with other treatment modalities (chemotherapy, antiangiogenic agents, radiotherapy), or with other immune modulators. Expert opinion: Immune checkpoint inhibitors have been established as the new standard of care for patients with advanced NSCLC. They can be administered according to PD-L1 expression upfront as monotherapy or in combination with chemotherapy- regardless of PD-L1 status - or in the later lines of therapy. They also represent a less toxic and more effective treatment choice than chemotherapy alone. The development of reliable biomarkers for patient selection and the subsequent use of the appropriate immune-based approach for each patient will define the role of immunotherapy in the years to come.