The safety of nivolumab for the treatment of advanced non-small cell lung cancer

Abstract

Immune checkpoint blockaders (ICBs) act by unbalancing the immune system, thus favoring the development of an immune-mediated antitumor effect. ICBs targeting the programmed cell death receptor-1 (PD-1) have recently been investigated in a number of advanced tumors, including non-small cell lung cancer (NSCLC). Nivolumab, a fully human IgG4 kappa directed against PD-1, has been the first ICB to be approved for second-line treatment of advanced NSCLC. Areas covered: In this review we focus on the clinical development of nivolumab for the treatment of advanced NSCLC, with an emphasis on its safety profile. In addition, we summarize the most common types of immune-related adverse events (irAEs) associated with nivolumab, mainly due to organ inflammation secondary to autoimmunity. Expert opinion: Nivolumab is the preferred treatment option for platinum-pretreated advanced NSCLC, having convincingly shown higher efficacy compared with standard docetaxel chemotherapy in phase III trials. The same trials showed far less incidence of either any grade and severe treatment-related AEs with nivolumab compared with chemotherapy. IrAEs associated with nivolumab are rarely severe in intensity, and often resolve with prompt management. Future studies will explore nivolumab in combination strategies with either platinum-based chemotherapy or other ICBs in treatment-naïve advanced NSCLC patients.

Programmed death ligand-1 inhibitors potentially carry a lower risk of pneumonitis compared with programmed death-1 inhibitors in patients with non-small cell lung cancer

“…The PD-L1 inhibitor durvalumab has been reported to be effective against stage III NSCLC when used after chemoradiotherapy (6). As these drugs are associated with serious and potentially fatal immune-related adverse events (irAE) (7)(8)(9), patients treated with immune checkpoint inhibitors must be monitored carefully. The recent development of checkpoint inhibitors has increased the number of treatment options for various types of cancer, and clinicians can have difficulty choosing the optimal agent.…”

Immune checkpoint inhibitors in Cancer patients with rheumatologic preexisting autoimmune diseases: a systematic review and meta-analysis

“…Although ICIs, including antibodies against PD-1/PD-L and CTLA-4, have yielded satisfying outcomes in terms of patient survival, they can also disrupt self-tolerance and lead to unique irAEs [ 43 , 44 ]. With the widespread application of ICIs in patients with advanced malignant tumors, irAEs caused by ICIs have been adequately discussed in a series of clinical trials [ 45 , 46 ]. Translational studies have shown that multiple pathways, such as cytokine, autoreactive T-cell and autoantibody pathways, may affect the development of irAEs [ 42 ].…”

Synchronous Occurrence of Bazex Syndrome and Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome in a Patient with Lung Cancer

“…Immune checkpoint inhibitors (ICIs) might have modified the immune response associated with the paraneoplastic syndromes. Recently, ICIs have been widely used in cancer therapy, including lung cancer (16-18). However, ICIs are known to exacerbate preexisting autoimmune disease (19, 20).…”