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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

[ Vol. 11 , Issue. 1 ]

Author(s):

Assunta Sgambato, Francesca Casaluce, Paola C. Sacco, Giovanni Palazzolo, Paolo Maione, Antonio Rossi, Fortunato Ciardiello and Cesare Gridelli   Pages 62 - 68 ( 7 )

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.

Keywords:

immune-related adverse events, immunotherapy, management toxicities, nivolumab, PD-1 inhibitors, PD-L1 inhibitors, pembrolizumab.

Affiliation:

Division of Medical Oncology, “S. G. Moscati” Hospital, Avellino, Italy.



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