Avelumab: another active immune checkpoint inhibitor in non-small cell lung cancer

Inhibitors of the immune checkpoints PD-1 and PD-L1 have changed the standard of care and clinical outcome of patients with many cancer types. For example, patients with advanced non-small cell lung cancer (NSCLC) were traditionally treated with chemotherapy with or without anti-angiogenic agents if their tumors did not carry actionable driver mutations. The use of immune checkpoint inhibitors provided additional options, in both the first-line and second-line settings, for these patients with clinically significant, often durable responses and prolonged survival. Nivolumab, an anti-PD-1 antibody, has been approved for both advanced non-squamous and squamous NSCLC in the second-line setting, after it demonstrated superior overall survival to docetaxel in large randomized phase 3 trials (1,2). Pembrolizumab, another anti-PD-1 antibody, has been approved for previously treated, PD-L1 positive, advanced NSCLC (3). The same applies to atezolizumab, an anti-PD-L1 monoclonal antibody (4). In addition, pembrolizumab also received regulatory approval as first-line therapy for PD-L1 positive NSCLC (5). The combination of pembrolizumab and carboplatin/pemetrexed as first-line therapy for non-squamous NSCLC has also demonstrated superior response rate and progression-free survival to chemotherapy alone, and is approved for use in the US (6).