Issues and Challenges in NSCLC Immunotherapy
Immunotherapy is a modern and extremely promising treatment for non-small cell lung cancer (NSCLC) patients, often providing long-term clinical benefits or even, in some cases, a complete recovery. Although many patients can now benefit from this form of treatment, the major limitations include high variability in response to treatment and difficulties in the proper qualifications for therapy.
Precise predictive factors for immunotherapy have not been determined yet, and this remains subject to further research. Examination of PD-L1 expression on cancer cells and tumor mutation burden (TMB) in qualification for immunotherapy is insufficient. Relatively often the response to immunotherapy can be observed in patients without these predictive factors. On the other hand, the lack of benefit from immunotherapy may occur in patients with a high percentage of cancer cells expressing PD-L1 and high TMB. The effectiveness of immunotherapy in NSCLC patients may be affected by the axis of microRNA - mRNA, PD-L1 gene status, tumor mutation burden, and molecular heterogeneity of the tumor.
Nowadays, immunotherapy is used in new indications. Neoadjuvant and adjuvant immunotherapy in NSCLC is developing dynamically. However, most often immunotherapy is used in locally advanced and advanced NSCLC patients. Unfortunately, the disease may progress during initially effective immunotherapy. The resistance mechanisms to immunotherapy are not yet fully understood and methods to overcome them must be developed. The impact of immunotherapy duration and its interruption on the effectiveness of treatment in NSCLC patients has not been determined either.
Finally, the possibility of using immunotherapy in NSCLC patients with viral infections or in transplant patients, as well as patients with autoimmune diseases has not been sufficiently studied. The likelihood of reactivation of viral infections (e.g. development of acute liver and another organ failure in the course of EBV or CMV infections), exacerbation of autoimmune diseases, as well as the risk of transplant rejection are a very serious problem in patients receiving immunotherapy.
In this Research Topic, we would like to discuss the issues mentioned above and challenges in NSCLC immunotherapy. Relevant manuscript submissions in a form of Original Research, Review, and Mini-review articles will be considered.
Immunotherapy: Open access
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