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Immunotherapy in non-small cell lung cancer harbouring driver mutations

*May 2021*

  • 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.

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