Immunotherapy in the treatment of non-small cell lung cancer (NSCLC) - analysis of epidemiology and cure – review
| Main Authors: | Ruszel, Kinga, Piecewicz-Szczęsna, Halina |
|---|---|
| Format: | Article Journal |
| Terbitan: |
, 2020
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| Online Access: |
https://zenodo.org/record/3986486 |
Daftar Isi:
- Ruszel Kinga, Piecewicz-Szczęsna Halina. Immunotherapy in the treatment of non-small cell lung cancer (NSCLC) - analysis of epidemiology and cure – review. Journal of Education, Health and Sport. 2020;10(8):204-213. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.08.024 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.08.024 https://zenodo.org/record/3986486 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 20.07.2020. Revised: 25.07.2020. Accepted: 15.08.2020. Immunotherapy in the treatment of non-small cell lung cancer (NSCLC) - analysis of epidemiology and cure – review Kinga Ruszel1, Halina Piecewicz-Szczęsna2 1Student Scientific Circle at the Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin 2Chair and Department of Epidemiology and Clinical Research Methodology, Medical University of Lublin Corresponding author: Halina Piecewicz-Szczęsna, e-mail: halpiec@gmail.com ORCID ID: Kinga Ruszel orcid.org/0000-0002-9633-4288 kingaruszel@gmail.com Halina Piecewicz-Szczęsna orcid.org/0000-0002-0573-7226, halpiec@gmail.com Summary Cancer is the second leading cause of death in Poland. Lung cancer is the leading cause of cancer-related mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for over 85% of all cases. Cancer incidence and mortality trends observed in the world and also Poland for many years, have been the resultants of changes associated with exposure to tobacco smoke carcino-gens (active smoking). Until recently, chemotherapy was the main treatment for NSCLC patients. Currently, thanks to the development of numerous research centers around the world, there are several methods of treating patients, which leads to the extension of cancer patients' lives and the improvement of their quality. The immune system plays an important role in controlling and eradicating cancer. Immune checkpoint inhibitors (ICPs) have shown clear persistent responses and represent the emergence of a new approach to treating patients with NSCLC. PD-1 inhibitors and PD-L1 inhibitors are a group of checkpoint inhibitors being developed for the treatment of cancer. Programmed cell death 1 (PD-1) is an inhibitory receptor expressed by activated T cells that down modulates effector functions and limits the generation of immune memory. Immunotherapy with monoclonal antibodies targeting with PD-1 and PD-L1 has become standard of care for an increasing number of indications. However, many patients with metastatic non-small cell lung cancer (mNSCLC) experience disease progression after first- and second- line treatment; therefore more treatment options are needed for these patients. Due to the specific characteristics of cancer immunotherapy and the rapid advances in this field, clinical guidelines for the use of these drugs are needed, including patient selection, response monitoring, careful observation of side effects, and biomarker testing. Aim The literature was searched to evaluate recommendations for drug initiation for targeted immunotherapy in non-small cell lung cancer (NSCLC). The evidence-based recommendations are designed to help doctors incorporate immune checkpoint inhibitors into the treatment plan of NSCLC patients. The aim of the review was also to check the latest data on the epidemiology of non-small cell lung cancer morbidity in order to compare the effectiveness of treatment over several years. The aim of the study is to review the standards of NSCLC treatment in terms of effectiveness, safety and patients’ quality of life. Materials and methods World literature and scientific articles have been reviewed. The PubMed and Google Scholar databases and the National Cancer Registry in Poland were searched in July and August 2020. We used medical terms (MeSH) "non-small cell lung cancer", "immunotherapy", "ICPs", "durvalumab ". No language restrictions were added. Conclusion Advanced non-small-cell lung cancer is still a challenging disease. Chemotherapy and EGFR or ALK tyrosine kinase inhibitors are well-established options. Immunotherapy with immune-checkpoint inhibitors significantly improves survival both in first- and second-line treatment. Generally, it can be stated that the function of CTLA-4 and PD-1 receptors is to inhibit the activity and proliferation of T lymphocytes. However, monoclonal antibodies against negative CTLA-4 or PD-1 receptors (ICPs) eliminate their inhibitory effect on T lymphocytes. In the case of PD-1, the same effect can be achieved by blocking the PD-L1 ligand. Immunotherapy has more advantages than chemotherapy. First of all, it is characterized by low cytotoxicity in relation to healthy cells and long-term cure rate in patients with even advanced cancer. Some caution should be exercised in analyzing the results of studies, as immunological treatment is characterized by high inter-individual variability in response to therapy, sometimes a large extension of treatment effects over time, and the possibility of transient progression before final tumor regression. Antibody-related side effects usually appear 8-10 weeks after initiating therapy, they are not serious, but relatively common (up to 60% of cases). Despite the encouraging results of previous studies, it is necessary to find objective markers for estimating the benefits of treatment, to reduce the amount of side effects and normalise the prices of new drugs. Key words: immunotherapy, NSCLC, epidemiology, PD1, PDL-1, oncology