PD-1 Inhibitors in Non-Small Cell Lung Cancer: Advances in Immunotherapy and Future Prospects

PD-1 inhibitors, such as pembrolizumab and nivolumab, have transformed the treatment landscape for advanced non-small cell lung cancer (NSCLC), offering substantial improvements in survival.Pembrolizumab, particularly effective in tumors with high PD-L1 expression (50%), has demonstrated significant overall survival (OS) and progression-free survival (PFS) benefits as monotherapy, and when combined with chemotherapy for patients with lower PD-L1 expression or EGFR/ALK-negative mutations.Clinical trials like KEYNOTE-024, KEYNOTE-189, and KEYNOTE-407 have reinforced the efficacy of pembrolizumab, showcasing its impact in both non-squamous and squamous NSCLC subtypes.Nivolumab, combined with ipilimumab, has also shown promise, especially in patients with PD-L1 expression 1%, as evidenced by the CheckMate-227 and CheckMate-9LA trials.As second-line therapy, both pembrolizumab and nivolumab have demonstrated efficacy in patients progressing after platinum-based chemotherapy, further solidifying their role in NSCLC management.Biomarkers such as PD-L1 expression and tumor mutational burden (TMB) play a crucial role in guiding immunotherapy choices, ensuring a more personalized treatment approach.Despite the benefits, PD-1 inhibitors are associated with immune-related adverse events (irAEs) that require careful management.The future of NSCLC treatment lies in optimizing biomarker-driven strategies, improving combination therapies, and addressing challenges such as resistance to immunotherapy.PD-1 inhibitors represent a major advancement, significantly improving outcomes for patients with advanced NSCLC.