Immune oncology (IO) and metastatic lung cancer [CBD]: Curability, bony metastasis and duration of therapy

Abstract

The introduction of immune checkpoint inhibitors (ICI) instigated significant improvement in the management of metastatic NSCLC. Currently, metastatic NSCLC remains in the category of ‘incurable’ malignancies and there is no biologic or mechanistic basis to guide the duration of treatment with immunotherapy. Generally, ICIs are continued until progression, unacceptable toxicity occurs or for an arbitrary 2 years. We present a case of stage IV NSCLC with bulky disease and several adverse prognostic factors who demonstrated remarkable benefits, arguably amounting to cure using a much shorter pembrolizumab course (4 months) and has remained free of progression off cancer therapy for 42 months. This case raises several important points regarding the current treatment approach and objective in metastatic NSCLC. Moreover, we argue that the management of metastatic bone disease may need reconsideration when immunotherapy is used considering the known adverse impact of radiation on immune cells. Lastly, we propose the consideration of c-reactive protein as a putative marker which may function as an objective tracer of metastatic activity providing the oncologist with a useful tool in managing such patients with ICI.

Keywords

• Cure
• Immune oncology
• immune checkpoint inhibitors
• bone metastasis
• Duration of immunetherapy