Assessing the Impact of Immunotherapy on Quality of Life and Patient Outcomes in the Frontline Management of Advanced Non−Small Cell Lung Cancer

Immune checkpoint inhibitors (ICIs) represent a significant benefit for the initial treatment of patients with advanced or metastatic non−small cell lung cancer (NSCLC). Beyond clinical benefit of increased overall survival, it represents a class of medications with a favorable adverse effect profile compared with chemotherapy. Drugs that target programmed cell death protein 1 (PD-1) receptor and its ligand PD-L1 are ICIs that work by taking the brakes off the immune system and promote T-cell−mediated cancer cell destruction. Current NCCN guidelines recommend that all patients with advanced or metastatic NSCLC have their PD-L1 status (amount of PD-L1 on cancer cells) assessed to guide treatment section. However, this recommendation is not always followed and may lead to inappropriate treatment selection and potential increased cost. Through appropriate biomarker testing, subsequent appropriate utilization of ICIs may help to drive down other costs and improve health-related quality of life. Managed care pharmacists should continue to focus on promotion of guideline concordant care that includes appropriate biomarker testing and selection of an evidence-based preferred treatment option.

The frontline treatment paradigm for patients with advanced or metastatic non−small cell lung cancer (NSCLC) has changed dramatically in the past decade amid efforts to tackle this leading cause of cancer-related mortality. Immune checkpoint inhibitors (ICIs) targeting the programmed cell death protein 1 (PD-1) receptor and its ligand PD-L1 are an important therapeutic option for patients whose tumors lack genetic alterations that dictate response to molecularly targeted therapies. With a growing number of FDA-approved ICI monotherapy and combination therapy options for first-line therapy, the use of biomarkers such as PD-L1 expression has become increasingly important in guiding therapeutic decision making. Presently, PD-L1 expression remains a key biomarker in this setting, in spite of its limitations. This article will evaluate the current and evolving clinical trends in the use of ICIs in the frontline management of metastatic NSCLC, as well as the challenges associated with PD-L1 expression analysis and biomarker implementation.