Immune checkpoint inhibitors for mutated non–small cell lung cancer

Lung cancer is a major health concern in Canada. Early detection is critical, but more than 50% of non–small cell lung cancer (NSCLC) cases are diagnosed at stage IV, impacting survival rates. Oncogenic driver mutations in genes like epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK), which are present in a subset of NSCLC, have led to the development of targeted therapies, improving outcomes. Immune checkpoint inhibitors (ICIs) such as atezolizumab, nivolumab, and pembrolizumab can also be given to patients with NSCLC. While guidelines recommend using ICIs after targeted therapy and chemotherapy, uncertainties persist regarding their benefits in later lines of therapy and compared with alternative chemotherapy. Addressing this issue will involve assessing ICI effectiveness in advanced NSCLC, considering specific driver mutations, and evaluating their place in the treatment sequence.

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