Circulating biomarkers as predictors of response to immune checkpoint inhibitors in NSCLC: Are we on the right path?
Calogera Claudia Spagnolo, Francesco Pepe, Giuliana Ciappina, Francesco Nucera, Paolo Ruggeri, Andrea Squeri, Desirèe Speranza, Nicola Silvestris, Umberto Malapelle, Mariacarmela Santarpía
Abstract
Immune checkpoints inhibitors (ICIs) have markedly improved the therapeutic management of advanced NSCLC and, more recently, they have demonstrated efficacy also in the early-stage disease. Despite better survival outcomes with ICIs compared to standard chemotherapy, a large proportion of patients can derive limited clinical benefit from these agents. So far, few predictive biomarkers, including the programmed death-ligand 1 (PD-L1), have been introduced in clinical practice. Therefore, there is an urgent need to identify novel biomarkers to select patients for immunotherapy, to improve efficacy and avoid unnecessary toxicity. A deeper understanding of the mechanisms involved in antitumor immunity and advances in the field of liquid biopsy have led to the identification of a wide range of circulating biomarkers that could potentially predict response to immunotherapy. Herein, we provide an updated overview of these circulating biomarkers, focusing on emerging data from clinical studies and describing modern technologies used for their detection. • Immunotherapy has recently revolutionized survival outcomes in NSCLC patients. • Disease progression or resistance after variable periods of time are still experienced. • Liquid biopsy has led to the identification of several circulating biomarkers. • Circulating biomarkers emerge as promising tool to predict immunotherapy benefit. • There are still several issues that limit on the diffusion of these biomarkers.