A study explained the growing importance of immunotherapy as a therapeutic approach to treat cancer, where several phase III studies exhibited survival advantages and castration-resistant prostate cancer. Thus, a potential target for the next generation of immune-based strategies would be non-small cell lung cancer (NSCLC). In that study, the researchers explored the present state of the art in lung cancer immunotherapy, which included vaccines that would specifically target lung tumor antigens and immune checkpoint antibodies, such as anti-programmed death 1 (anti-PD-1). Both methods exploited the innate immunity against tumors by suppressing tumor-induced immune paresis.

Researchers explored the PubMed and Medline databases using the terms “immunotherapy” and “NSCLC,” and numerous other therapy-specific terms to recognize pertinent clinical trials of immunotherapy in NSCLC. They also assessed various abstracts presented at international lung cancer symposia, the American Society of Clinical Oncology annual meeting, and the European Society of Medical Oncology yearly meeting between 2005 and 2013. 

 In both the adjuvant and metastatic disease settings, the researchers found NSCLC vaccine’s large international phase III trials had completed accrual. The results from START (Stimulating Targeted Antigenic Responses To NSCLC) disappointed the researchers but still awaited outcomes from other studies. They saw potential in immune checkpoint modulation, where separate phase I studies of the anti-PD-1 antibody, nivolumab, and anti-PD-L1 antibody, MPDL3280A, demonstrated good tolerance and durable responses for certain patients with NSCLC who were heavily pretreated.

 They found immune-based strategies had shown initial potential for early- and advanced-stage NSCLC. But, they faced new challenges, where they had to validate their findings in randomized studies and discover durable biomarkers of response.