First-line immunotherapy for patients with metastatic non-small cell lung cancer not eligible for a platinum-based chemotherapy

Abstract

Immune checkpoint inhibitors alone or in combination with platinum-based doublet chemotherapy is the standard first-line treatment for patients with metastatic non-small cell lung cancer (mNSCLC) without driver mutations. It should be recognized, however, that treating patients who are not eligible for platinum-based chemotherapy owing to factors such as comorbidities, age, or poor performance status pose difficult challenges to the treating clinician. For a long time, monochemotherapy was the only treatment option for these patients, despite its limited efficacy and significant toxicity. The perception of the efficacy and safety of immunotherapy in this patient group was based primarily on personal experience and isolated clinical observations, as these patients were frequently excluded from clinical trials. IPSOS was the first and, to date, the only randomized phase III trial dedicated to that patient population to demonstrate that treatment with atezolizumab was effective in terms of both objective response rate and overall survival, with a favorable toxicity profile. This article presents two clinical cases illustrating atezolizumab clinical application in elderly patients with significant comorbidities and advanced mNSCLC who were ineligible for chemotherapy. In both cases, treatment with atezolizumab resulted in the reduction of clinical symptoms and provided longterm disease control without deterioration in quality of life. These clinical observations confirmed the efficacy of atezolizumab therapy in platinum-ineligible patients with mNSCLC in real-world clinical practice, regardless of tumor PD-L1 expression level.