Is Immunotherapy Beneficial in Patients with Oncogene-Addicted Non-Small Cell Lung Cancers? A Narrative Review

Simple Summary Patients with non-small cell lung cancer (NSCLC) have a number of possible systemic treatment options, including targeted therapy, chemotherapy, immunotherapy, or antibody-drug conjugates. Approximately two thirds of lung adenocarcinomas have changes in single genes ('oncogenes' or oncogenic driver alterations), which drive the growth of these cancers. The role of immunotherapy in these cancers is debated, and may be different depending on the mutation present. In this review, we summarize current evidence regarding the use of immunotherapy in specific genomically driven subsets of lung adenocarcinoma. We analyze this in terms of specific mutations, focusing on both efficacy and toxicity, and potential future directions.Abstract Over the past 20 years, there has been a paradigm shift in the care of patients with non-small cell lung cancer (NSCLC), who now have a range of systemic treatment options including targeted therapy, chemotherapy, immunotherapy (ICI), and antibody-drug conjugates (ADCs). A proportion of these cancers have single identifiable alterations in oncogenes that drive their proliferation and cancer progression, known as "oncogene-addiction". These "driver alterations" are identified in approximately two thirds of patients with lung adenocarcinomas, via next generation sequencing or other orthogonal tests. It was noted in the early clinical development of ICIs that patients with oncogene-addicted NSCLC may have differential responses to ICI. The toxicity signal for patients with oncogene-addicted NSCLC when treated with ICIs also seemed to differ depending on the alteration present and the specific targeted agent used. Developing a greater understanding of the underlying reasons for these clinical observations has become an important area of research in NSCLC. In this review, we analyze the efficacy and safety of ICI according to specific mutations, and consider possible future directions to mitigate safety concerns and improve the outcomes for patients with oncogene-addicted NSCLC.