EGFR mutation positive non-small cell lung cancer: can we identify predictors of benefit from immune checkpoint inhibitors

Monoclonal antibodies directed against the programmed death-1 (PD-1) receptor have demonstrated consistent survival improvement in comparison to second-line chemotherapy with docetaxel, in patients with advanced non-small cell lung cancer (NSCLC), across multiple histologic subtypes. However, this benefit is less clear in some subgroups of patients, including never smokers and patients with tumors harboring activating driver mutations, such as mutations of the epidermal growth factor receptor (EGFR) gene. Sub-group analyses of several phase III clinical trials comparing the immuno-oncology (IO) agents, nivolumab, pembrolizumab, or atezolizumab, with docetaxel, have failed to demonstrate superior efficacy of IO in patients with EGFR mutated tumors when compared to standard of care chemotherapy (1-3).