Intricacies of Checkpoint Inhibition in NSCLC

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Immune checkpoint inhibitors have demonstrated high levels of antitumor activity in patients with non-small cell lung cancer (NSCLC). Despite this, excitement over efficacy should not overshadow the potential side effects associated with these therapies, including autoimmunity, notes Anne S. Tsao, MD.

A few of the more critical side effects associated with PD-1 inhibition include colitis, fatigue, and pneumonitis. While diarrhea is a common toxicity of many treatments, it is more serious with the immunotherapies, as it is often coupled with colitis, Tsao suggests. Steroids could represent a potential treatment for many of these side effects, suggests Mark A. Socinski, MD.

Pseudo-progression, which is characterized by tumor growth followed by sustained shrinkage, represents a unique phenomenon associated with immune checkpoint inhibitors, notes Heather A. Wakelee, MD. This should be considered when assessing a patient for response. In general, scans should be assessed in addition to symptoms and other patient characteristics.

Various patient and tumor characteristics, including smoking status, histologies, and mutations, are associated with responses to immunotherapy, explains Roy S. Herbst, MD. In contrast to the lack of success with many other current therapies, studies are seeing activity with immunotherapy in patients with squamous cell NSCLC, smokers, and in tumors that harbor KRAS mutations.