PD-1/PD-L1 Inhibitors Across NSCLC Treatment Settings

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Many of the immune checkpoint inhibitors result in a radiographic abnormality that resembles progression on scans; however, after time the tumor begins to regress, explains Mark A. Socinski, MD. This pseudoprogression is common with immunotherapy and makes measuring response difficult. The appearance of symptoms can be used to ascertain whether it is genuine progression or pseudoprogression.

Clinical trials are assessing PD-1 and PD-L1 inhibitors across a variety of settings, including the frontline, adjuvant, and locally advanced setting. Additionally, these agents have been proposed as possible maintenance therapies.

In many of these settings, treatment includes chemoradiation, which can result in pneumonitis. The common treatment for this adverse event is the administration of steroids. At this point, it appears that steroids will not impact the efficacy of the PD-1 inhibitors.

The Lung-MAP trial is recruiting patients with advanced or incurable stage IIIB/IV squamous cell carcinoma following progression on frontline platinum-containing chemotherapy regimen for metastatic non-small cell lung cancer. The study will randomize patients to a treatment based on results from the FoundationOne test, which analyzes 182 genes. Patients without an actionable mutation will receive the PD-L1 inhibitor MEDI4736 in comparison with docetaxel.