Treatment of Pulmonary Adenocarcinoma With Immune Checkpoint Inhibitors

Abstract

Immune checkpoint inhibitors targeting the PD-1/PD-L1 pathway are now a proven treatment modality for pulmonary adenocarcinoma and are applicable to the large majority of patients. Clinical meaningful benefits in overall survival and/or progression-free survival (PFS) have been reported in stage IV patients as second-line treatment after chemotherapy, as first-line treatment in patients with tumors expressing high levels of the ligand PD-L1, and in patients receiving the combination of chemotherapy plus a PD-1 or PD-L1 inhibitor as first-line therapy. Recently, substantial prolongation of PFS has been reported using a PD-L1 inhibitor after curative treatment of unresectable stage III patients. Important unanswered questions include the optimal biomarker to select patients for single-agent checkpoint inhibitor therapy, the duration of treatment in responding patients, and their use in patients with oncogenic mutations targetable by existing tyrosine kinase inhibitors. The results of adjuvant trials in resected stages I-III disease are awaited and many combinations of checkpoint inhibitors and checkpoint inhibitors with other therapeutics are in clinical development. This chapter will discuss the current state of the art of this exciting and rapidly developing treatment.