Immune checkpoint blockade (ICB) for first line treatment in non-small-cell lung cancer (NSCLC)

Non-small-cell lung cancer (NSCLC) is a dismal disease with a significant death toll, since, at the time of diagnosis, the disease is frequently disseminated (Stage IV), or locally advanced, and rapidly evolves to metastatic disease. In spite of adjuvant therapy, recurrence after surgery often occurs. Response to cisplatin-based chemotherapy is meager and radiographic response only reaches 30% (incomplete or partial response), with a short progression free survival (PFS) of 4–5 months and median survival of 10–12 months, with or without the addition of bevacizumab or EGFR monoclonal antibodies. Immune checkpoint blockade (ICB) or immune checkpoint antibody inhibitors have revolutionized the treatment of lung cancer, as well as other tumors. Recent data show that ICB and pembrolizumab (a PD-1 inhibitor) induce response rate in brain metastases of melanoma and NSCLC patients in a similar proportion found in systemic disease, between 20–30% (1,2).