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Role of immunotherapy in stage III nonsmall cell lung cancer

Wrona, Anna

doi: 10.1097/CCO.0000000000000493
LUNG AND MEDIASTINUM: Edited by Robert Pirker

Purpose of review Despite aggressive treatment based on definitive chemoradiotherapy, 5-year overall survival in unresectable stage III nonsmall cell lung cancer remains poor (15–20%). The novel immunotherapy based on immune checkpoint inhibitors (ICIs) presents as the therapeutic ‘Holly Grail’ in lung cancer treatment.

Recent findings Preclinical models provide evidence of immunotherapy–radiotherapy (IM-RT) synergy. The exposure to ionizing radiation turns tumor in an in-situ vaccine, primes the innate immune system, increases immunotherapy efficacy by overcoming the immunosuppressive microenvironment of immune-resistant tumors and promotes a systemic, out-of-field antitumor T-cell-mediated response called abscopal effect. The immunomodulatory and abscopal effects of radiotherapy can be further enhanced by combining with systemic immunotherapies. The phase III START trial proved that liposomal vaccine – tecemotide (L-BLP25) administered as maintenance therapy after concurrent chemoradiotherapy (CRT) in LA-NSCLC prolongs survival. In the phase III PACIFIC trial consolidation with durvalumab, an anti-PDL-1 antibody, was associated with survival benefit in patients diagnosed with LA-NSCLC who responded to concurrent chemoradiotherapy.

Summary PACIFIC trial results are expected to definitely establish durvalumab as standard consolidation strategy in LA-NSCLC. Many clinical trials are ongoing in the field of immunoradiotherapy in LA-NSCLC to define the optimal conditions for this therapeutic combination.

Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland

Correspondence to Anna Wrona, MD, Department of Oncology and Radiotherapy, Medical University of Gdańsk, 7 Dębinki Street, 80–211 Gdańsk, Poland. Tel: +48 58 349 2272; fax: +48 58 349 2210; e-mail: wronania@gmail.com,annawrona@gumed.edu.pl

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