The Evolving Landscape of Immunotherapy in NSCLC

Luis E. Raez, MD: We are now using immunotherapy in a lot of patients with lung cancer. It has been very exciting for us with the approval of the 3 major immunotherapeutic drugs for second-line. We got approval of nivolumab first, then we got approval of pembrolizumab for patients that are immunohistochemistry-positive, and recently, we got approval of atezolizumab. And then, we got approval of pembrolizumab for first line in the patient who has a strong immunohistochemistry for PD-L1. So, that is why it’s very exciting for us because we have a large number of patients in immunotherapy instead of palliative chemotherapy.

Atezolizumab is interesting because it’s the first anti—PD-L1. There is an interaction between the PD-1 receptor from the lymphocyte and the PD-L1 ligand from the tumor. The first 2 drugs were aimed to target the receptor, the PD-1, and atezolizumab is the first one to target the ligand. It’s called anti–­PD-L1. And there are more agents coming that are anti–PD–L1. Of course, the debate is, which one is better? Are there are any differences between them? We don’t know that yet, but that’s a way that they are different from each other. Clinically speaking, all of the 3 agents are approved for second line. So, atezolizumab has a similar approval. And atezolizumab does not require immunohistochemistry testing for PD-1, PD-L1. It’s approved without the need to do testing.