The role of nivolumab combined to immunotherapy and/or chemotherapy in the first-line treatment of advanced Non Small Cell Lung Cancer

Introduction: One of the latest breakthroughs in the treatment of advanced Non Small Cell Lung Cancer (NSCLC) is represented by PD-1/PD-L1-targeting Immune Checkpoint Inhibitors (ICIs). However, only a limited subset of advanced NSCLC patients can receive first-line ICI monotherapy (advanced NSCLC patients without driver mutations and with a PD-L1 expression >= 50% or >= 1%) and naive ICI-respondent patients represent an even more limited subgroup of patients, which eventually experience progression of disease after approximately 7-11 months. Therefore, different strategies are being evaluated to obtain a higher response rate and a more durable clinical response in this setting. A very encouraging one is represented by ICI-combination therapies, i.e. the use of an ICI combined to cytotoxic chemotherapy and/or another immunotherapeutic agent. Areas covered: This paper aims to assess currently available data from trials evaluating nivolumab-based first-line combination therapies. Expert opinion: Nivolumab-based combinations regimens will represent one of the standard treatments for naive advanced NSCLC patients in a near future. However, in order to fully exploit these combination therapies, additional studies assessing potential predictive and/or prognostic biomarkers are required to better clarify which patients are more likely to benefit from these regimens, alongside with studies investigating safer and more durable second-line treatments.

Automated summary

The latest breakthrough in advanced Non Small Cell Lung Cancer (NSCLC) treatment is PD-1/PD-L1-targeting Immune Checkpoint Inhibitors (ICIs), which are being evaluated in combination therapies to achieve higher response rates and more durable clinical response. Nivolumab-based combination regimens are expected to become standard treatments for naive advanced NSCLC patients in the near future, but further studies on predictive and prognostic biomarkers are necessary to identify which patients will benefit the most from these regimens. Additionally, research on safer and more durable second-line treatments is also crucial.