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World J Clin Oncol. Dec 24, 2021; 12(12): 1182-1192
Published online Dec 24, 2021. doi: 10.5306/wjco.v12.i12.1182
Immunotherapy combinations and chemotherapy sparing schemes in first line non-small cell lung cancer
María Sereno, Oliver Higuera, Patricia Cruz Castellanos, Sandra Falagan, Xabier Mielgo-Rubio, Juan Carlos Trujillo-Reyes, Felipe Couñago
María Sereno, Sandra Falagan, Medical Oncology Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes 28702, Madrid, Spain
Oliver Higuera, Patricia Cruz Castellanos, Medical Oncology Department, Hospital Universitario La Paz, Madrid 28046, Spain
Xabier Mielgo-Rubio, Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Alcorcón 28922, Madrid, Spain
Juan Carlos Trujillo-Reyes, Department of Thoracic Surgery, Hospital de la Santa Creu I Sant Pau, Barcelona 08029, Catalonia, Spain
Juan Carlos Trujillo-Reyes, Department of Surgery, Universitat Autonoma de Barcelona, Barcelona 08029, Catalonia, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón 28223, Madrid, Spain
Felipe Couñago, Department of Radiation Oncology, Hospital La Luz, Madrid 28003, Spain
Felipe Couñago, Medicine Department, School of Biomedical Sciences, Universidad Europea de Madrid, Villaviciosa de Odón 28670, Madrid, Spain
Author contributions: Sereno M coordinated the literature review, performed the research, and wrote the manuscript; Higuera O, Cruz Castellanos P and Falagan S contributed to the writing of different parts of the manuscript; Mielgo-Rubio X, Trujillo JC and Couñago F critically reviewed the manuscript for intellectual content and all the authors approved the final version.
Conflict-of-interest statement: Mielgo-Rubio X reports personal fees and non-financial support from ROCHE, personal fees from ASTRA ZENECA, grants, personal fees and non-financial support from BMS, personal fees from MSD, personal fees from ABBOTT, personal fees from KIOWA-KIRIN, outside the submitted work. Rest of authors has nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: María Sereno, MD, PhD, Consultant Physician-Scientist, Medical Oncology Department, Hospital Universitario Infanta Sofía, Paseo Europa 34, San Sebastián de los Reyes 28702, Madrid, Spain. mariasereno75@gmail.com
Received: April 28, 2021
Peer-review started: April 28, 2021
First decision: July 16, 2021
Revised: July 28, 2021
Accepted: November 24, 2021
Article in press: November 24, 2021
Published online: December 24, 2021
Processing time: 240 Days and 1.3 Hours
Abstract

In recent years, studies have explored different combinations of immunotherapy and chemotherapy. The rationale behind these is the improved survival outcomes of new immunologic therapies used in first-line-treatment of advanced non-small cell lung cancer. Moreover, for the most-studied combinations of anti-programed death-1 (PD-1)/programed death ligand-1 (PD-L1) with the addition of platinum- based chemotherapy, recent research is investigating whether combining different immunologic antitumoral mechanisms of action, such as anti-PD-1/PD-L1 and anti-CTLA-4, or anti-PD-L1 and anti-TIGIT, with or without chemotherapy, can improve efficacy outcomes compared with more classical combinations, or compared with standard chemotherapy alone. Here, we present the data of the main randomized studies that have evaluated these combinations, focusing on the basic rationale behind the different combinations, and the efficacy and tolerability data available to date.

Keywords: Immunotherapy combinations; Anti- programmed cell death protein; Anti-programmed cell death ligand 1; anti-TIGIT; anti-CTLA-4; Combo; Non-small cell lung cancer

Core Tip: This review presents the results of the main articles reporting on immunotherapy combinations, with or without chemotherapy, focusing principally on efficacy and toxicity data. The convenience of adding shorter chemotherapy regimens vs the standard 4-cycle regimens to immunotherapy doublets is discussed.