Rechallenge of immunotherapy in non-small cell lung cancer patients - navigating indications and evolving perspectives

Indications for immunotherapy in patients with non-small-cell lung cancer (NSCLC) are expanding, with an increasing number of patients receiving immunotherapy in the perioperative setting or as consolidation of radiochemotherapy. Immune checkpoint inhibitor (ICI)-based regimens are also being used more and more often in the first -line systemic setting. However, in many cases, the efficacy of immunotherapy is limited, and it is necessary to determine the optimal sequence of systemic treatment. There is some theoretical rationale for repeated use of immune checkpoint inhibitors, but it is debatable which subgroups of patients are likely to benefit clinically from such treatment. Currently, data on the efficacy of immunotherapy retreatment are derived mainly from retrospective analyses and reviews of small subgroups of patients treated in clinical trials, making it difficult to draw reliable conclusions. There is a need for research identifying factors that will guide clinical decision-making, such as the time from the completion of immunotherapy, the initial response achieved, the expression of PD-L1, and others. It appears that patients who discontinued immunotherapy due to disease progression should not be requalified for treatment with currently available ICIs. Treatment in controlled clinical trials is the optimal strategy in such cases.