Management of Non-Small Cell Lung Cancer: The Era of Immunotherapy

Lung cancer is the most frequently diagnosed cancer type and the leading cause of cancer-related deaths worldwide. According to the last GLOBOCAN estimate of cancer incidence and mortality produced by the International Agency for Research on Cancer (IARC), lung cancer accounted for approximately 13% of cancer diagnoses in 2012, and an estimated 1.8 million new lung cancer cases were diagnosed. First-line treatment for Stage IV non-small cell lung cancer (NSCLC) has changed considerably, primarily as a result of a better patient selection on the basis of histology, molecular markers, and innovative treatment approaches. Recent data have highlighted the advent of immunotherapy as the major shift in treatment of advanced NSCLC. Three checkpoint inhibitors of the programmed death-1–programmed death-ligand 1 interaction, nivolumab, pembrolizumab, and atezolizumab, have already received U.S. Food and Drug Administration (FDA) approval for treatment of advanced NSCLC patients; however, despite impressive treatment responses in many patients who received immunotherapy, a cohort of patients failed to obtain significant results. This review summarises the emerging role of immunotherapy in NSCLC, emphasising the current unanswered questions about predictive biomarkers for treatment response, current treatments, and possible treatment combinations.