Immune checkpoint inhibitors in non-small cell lung cancer

Background. Modern immunotherapy with immunological checkpoint inhibitors has significantly extended the therapeutic options for patients with metastasized non-small cell lung cancer (NSCLC). Clinical trials with immunological checkpoint inhibitors in advanced NSCLC were analyzed for toxicity and efficacy parameters and comparatively evaluated. Phase I, phase II and phase III study results with checkpoint inhibitors in advanced NSCLC were searched for in PubMed and among abstracts of important international conferences (ASCO, ESMO, WCLC). For the two progammed death receptor (PD-1) antibodies nivolumab and pembrolizumab phase III trials in second-line and first-line therapy have already been published. Approval by the European Medicines Agency (EMA) are available for nivolumab (without a biomarker prerequisite, second-line) and pembrolizumab (PD-L1 expression ae<yen> 1% in tumor tissue, second and third-line) in advanced NSCLC. Pembrolizumab was the first drug to achieve approval for first-line therapy in PD-L1 high expressors (PD-L1 ae<yen> 50% tumor proportion score [TPS]). First results of phase III trials are also available for PD-L1 antibodies, such as atezolizumab (OAK trial) and are awaited for durvalumab (MYSTIC trial). For combinations with conventional chemotherapy and combinations with other checkpoint inhibitors mature results from randomized phase III trials are still awaited. Modern immunotherapy with PD-1 inhibitors has become established as an integral part of standard treatment algorithms for advanced NSCLC. In the future better predictive markers for this innovative treatment modality are needed to achieve a more selective administration of these highly effective but also highly specific drugs in advanced NSCLC.