Immunotherapy in daily practice

Question 1

What are the pros and cons of chemotherapy?

Answer 1

Chemotherapy is non-specific, intravenous, has high toxicity and relatively low costs, but response rates are only 30% and for 3/6 months.

Question 2

What are the pros and cons of targeted therapy?

Answer 2

Targeted therapy is directed at driver mutations/fusions, orally, has fewer toxicities and high costs, but response rates are 60-70% and for 1-2 years.

Question 3

What are the pros and cons of immunotherapy?

Answer 3

Immunotherapy is directed against PD-L1, intravenous, fewer toxicities, very high costs, the response rate is between 10-50% and for 1,5-2 years.

Question 4

What is the approach to systemic treatment of lung cancer?

Answer 4

First-line therapy: first look for oncogenic driven tumors, if they’re not found then look at tumor PD-L1 expression.
• If ≥50% = anti-PD-1 monotherapy (+/- chemo)
• If <50% = combination of chemotherapy and immunotherapy

Question 5

What are examples of immunotherapy?

Answer 5

Checkpoint inhibitors like PD-1, PD-L1, and CTLA4 inhibitors.

Question 6

What are the conditions for immunotherapy?

Answer 6

No oncogenic driven tumors, no auto-immune diseases, and no active infections.