Treatment beyond progression in non-small cell lung cancer: A systematic review and meta-analysis

Immune checkpoint inhibitors rechallenge in non-small cell lung cancer: Current evidence and future directions

Immunotherapy, remarkably immune checkpoint inhibitors (ICIs), has significantly altered the treatment landscape for non-small cell lung cancer (NSCLC). Despite their success, the discontinuation of ICIs therapy may occur due to factors such as prior treatment completion, disease progression during ICIs treatment, or immune-related adverse events (irAEs). As numerous studies highlight the dynamic nature of immune responses and the sustained benefits of ICIs, ICIs rechallenge has become an attractive and feasible option. However, the decision-making process for ICIs rechallenge in clinical settings is complicated by numerous uncertainties. This review systematically analyses existing clinical research evidence, classifying ICIs rechallenge into distinct clinical scenarios, exploring methods to overcome ICIs resistance in rechallenge instances, and identifying biomarkers to select patients likely to benefit from rechallenge. By integrating recent studies and new technologies, we offer crucial recommendations for future clinical trial design and provide a practical guideline to maximize the therapeutic benefits of immunotherapy for NSCLC patients.

Treatment Beyond Progression After Anti-PD-1 Blockade in Hepatocellular Carcinoma

Immune checkpoint inhibitors (ICI) can induce atypical tumor responses including pseudoprogression in a subset of patients who may benefit from treatment beyond progression. While ICIs have emerged as frontline treatments for hepatocellular carcinoma (HCC) and are associated with clinical benefit in a minority of patients, it is unclear whether treatment beyond progression has utility in this disease type. In a multicenter cohort analysis, treatment beyond progression was associated with no new safety signals, objective responses in 5.8% of patients, and disease control in 44% of patients. Progression-free survival and overall survival were comparable between patients treated beyond progression and patients treated with subsequent therapies, demonstrating that treatment beyond progression was not detrimental to survival outcomes. Rather, treatment beyond progression may benefit select patients with HCC and could represent a viable strategy for maximizing treatment benefit in these patients.

SIGNIFICANCE

Treatment beyond progression with ICIs in patients with HCC is safe and may benefit a subset of patients due to later-onset tumor responses or disease stability. These findings may guide the design of trials testing ICIs in HCC and the use of treatment beyond progression in routine practice.