Ramamurthy Chethan, Godwin James L, Borghaei Hossein
Department of Medical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA.
Curr Treat Options Oncol. 2017 Jun;18(6):33. doi: 10.1007/s11864-017-0476-y.
Immunotherapy is now an established part of the treatment paradigm for advanced non-small cell lung cancer (NSCLC), but the line of therapy and the sequence of agents are still in flux. In this time when much is to be learned, the optimal therapy for most patients in both the first-line and previously treated settings is in the context of a clinical trial. For standard therapy, however, there are good data to support the practice of programmed death-ligand 1 (PD-L1) testing in the front-line advanced setting and to use pembrolizumab as first-line therapy for those with ≥50% PD-L1 expression. In those who have progressed after receiving platinum-based chemotherapy in the first-line, multiple PD-1/PD-L1 agents are available and currently approved, including nivolumab, pembrolizumab, and atezolizumab. There are no data to suggest that one agent is more efficacious than the others, but pembrolizumab should be reserved for patients with PD-L1 expression ≥1%. Prescribers and patients must be cognizant of the toxicity profile of these agents, as severe immune-related adverse events can occur with therapy. At this time, this practice pattern for immunotherapy in the first- and second-line can be considered the standard of care, but new data are likely to impact the role of immunotherapy as monotherapy or in combination in the near future.
免疫疗法现已成为晚期非小细胞肺癌（NSCLC）治疗模式的既定组成部分，但治疗方案和药物使用顺序仍在不断变化。在这个仍有许多需要了解的时期，对于大多数一线和经治患者而言，最佳治疗方案是参加临床试验。然而，对于标准治疗，有充分的数据支持在一线晚期治疗中进行程序性死亡配体1（PD-L1）检测，并将帕博利珠单抗用于PD-L1表达≥50%的患者作为一线治疗。对于那些在一线接受铂类化疗后病情进展的患者，有多种PD-1/PD-L1药物可供使用且目前已获批准，包括纳武利尤单抗、帕博利珠单抗和阿替利珠单抗。没有数据表明一种药物比其他药物更有效，但帕博利珠单抗应仅用于PD-L1表达≥1%的患者。开处方者和患者必须了解这些药物的毒性特征，因为治疗可能会发生严重的免疫相关不良事件。目前，这种一线和二线免疫治疗的实践模式可被视为标准治疗，但新的数据可能会在不久的将来影响免疫疗法作为单一疗法或联合疗法的作用。
