Non-small cell lung carcinoma: understanding cancer microenvironment to drive immunotherapy and patients’ selection

Lung cancer is still the first cause of cancer-related death worldwide with non-small cell lung carcinoma (NSCLC) determining approximately 85% of all cases (1). Almost half of lung cancers present with metastases at the diagnosis. Several clinical options have been used, but prognosis remains poor especially in the advanced stages with about 5% of survivors after 5 years (2). Platinum-based chemotherapy remains the standard of care in the first line of treatment, although with a low rate of response ranging between 15–30% (3). In this scenario in the last few years, identification and targeting of programmed cell death-1 (PD-1) and one of its ligands, programmed cell death-ligand 1 (PD-L1), have shown extraordinary results in several cancer types. Consequently, nivolumab and pembrolizumab, two anti-PD-1 agents, has been approved by Food and Drug Administration (FDA) and European Medicines Agency (EMA) for first- or second-line of therapy in NSCLC