Dados do Resumo

Título

Immune Checkpoint Inhibitors In Lung Cancer Treatment

Introdução

Lung cancer is the second leading cause of death worldwide and it has 3 main histological types. Adenocarcinoma occurs due to mutations in KRAS and EGFR pathways, squamous cell carcinoma in TP53, CDKN2A, and RB genes, and small cell carcinoma undergoes MYC amplification and TP53 and RB suppression. Nowadays, molecular and genetic characteristics are crucial to develop new promising targeted therapies, including immune checkpoint inhibitors (ICI), despite their limitations and adverse effects.

Objetivo

Conduct a survey of the most commonly used ICIs in the treatment of primary lung cancer and determine whether they increase survival when compared to or added to chemotherapy.

Métodos

Systematic reviews and cohort studies published between 2020 and 2024, in English and Portuguese, referring to primary malignant lung neoplasms, were selected from the PubMed database, using the English terms "lung cancer", "immunotherapy", "checkpoint inhibitors", and "adenocarcinoma".

Resultados

Within the theme addressed, 2,048 results were found, 6 systematic reviews and 1 cohort study were selected based on inclusion criteria. The most mentioned immune checkpoints are: PD-1/PD-L1 (26.5%), TIGIT (15.75%), LAG-3 and TIM3 (both 10.5%). The most cited PD-1/PD-L1 inhibitors are atezolizumab (100%), nivolumab, and pembrolizumab (both 85%). VEGF (bevacizumab) and CTLA-4 (ipilimumab) inhibitors are also prevalent, being mentioned in 71.5% of the articles. An increase in mean survival was confirmed when using PD-1/PD-L inhibitors. Conventional chemotherapy combined with atezolizumab added to 42% (5.8 months) in median survival (MS). Pembrolizumab alone increased MS in 110% (15.8 months) compared with chemotherapy, and in 40% (4.6 months) if combined with chemotherapy, when compared with monotherapy. Nivolumab showed a mean increase in MS of 41% (3 months) compared with docetaxel, when associated with conventional treatment.

Conclusões

ICI-focused immunotherapy increased overall survival in patients with primary lung cancer, when compared or added to conventional chemotherapy. ICIs monotherapy was better than chemotherapy in tumors with high PD-L1 expression, while immunotherapy combined with chemotherapy is more effective than chemotherapy alone, regardless of PD-L1 expression3. New ICIs are in testing phase, such as TIGIT, LAG-3, and TIM-3. However, an obstacle to immunotherapy is the precarious evaluation and high cost.

Palavras Chave

Imunoterapia; Sobrevida; neoplasiapulmonar