- The advent of molecular targeted therapies and the more recent introduction of immune checkpoint inhibitors (ICIs) have altered and improved the therapeutic landscape of non-small cell lung cancer (NSCLC).
- ICIs confer a durable response in a subset of patients; however, their therapeutic role in oncogene-driven NSCLC remains unclear, as the vast majority of trials was conducted without patients harbouring established oncogenic mutations.
- The only randomised data available on the efficacy of ICIs on oncogene addicted NSCLC come from the IMpower 150 trial and concern only EGFR mutated NSCLC patients.
- At present, no biomarker is clearly predictive for response or benefit to ICIs in oncogene addicted NSCLC. These are often characterised by low tumour mutation burden (TMB) and a less inflammatory tumour microenvironment, poor in tumour-infiltrating CD8+ lymphocytes. PD-L1 can be constitutionally overexpressed without having any clinical significance.