Review of checkpoint immunotherapy for the management of non-small cell lung cancer

Shine Raju,1 Ranjit Joseph,2 Sameep Sehgal3 1Division of Geriatrics and Palliative Care, Case Western University, Cleveland, OH, USA; 2Division of Hematology and Oncology, University of North Carolina, Chapel Hill, NC, USA; 3Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA Abstract: Checkpoint immunotherapy uses highly selective humanized monoclonal antibodies against checkpoint signals such as programmed cell death receptor (PD-1) and programmed cell death ligand (PD-L1). By blocking these receptors and signals, the immune system can be reactivated to fight the tumor. Immunotherapy for advanced non-small cell lung cancer (NSCLC) has resulted in a new paradigm of treatment options resulting in improved survival and response rates and has a less severe yet unique toxicity profile when compared to chemotherapy. PD-1 inhibitors, nivolumab and pembrolizumab, and PD-L1 inhibitor, atezolizumab, are currently approved by regulatory authorities for the treatment of advanced NSCLC. This article provides a detailed review of these newer agents, their mechanism of action, side-effect profile, therapeutic indications and current evidence supporting their use in the management of NSCLC. Keywords: non-small cell lung cancer, PD-1 inhibitors, PD-L1 inhibitors, pembrolizumab, nivolumab, atezolizuma