Year: 2026
Type: editorial
Abstract: Word count: 533/1000 words Immune checkpoint inhibitors (ICPis) have revolutionized the therapeutic landscape of lung cancer with unprecedented survival gains in most of the clinical settings. After initial signals of activity in pretreated non-small cell lung cancer (NSCLC) in early 2010's (1,2), the use of ICPis has progressively changed the standard of care in 1 st line metastatic setting, locally advanced disease and, more recently, early-stage NSCLC (3,4). However, except for programmed death ligand 1 (PD-L1) tumor expression (tumor proportion score, TPS), with the inherited biological limitations of this biomarker, no other predictive factor has been approved for patient selection to these agents (5), posing several challenges in clinical practice. Furthermore, the use of ICPis in small cell lung cancer (SCLC) either in extensive stage or limited disease is regardless of PD-L1 status or any other predictive biomarker (6). The identification of predictive biomarkers is essential to reduce the costs of these treatments and to avoid unnecessary toxicities to patients who cannot benefit from these drugs. In this rapidly evolving therapeutic scenario, it is crucial to understand the bases of tumor response and resistance to drive a more rational development of novel immunotherapy-based strategies.The Research Topic "Predictive Biomarkers to Immune Checkpoint Inhibitors in Lung Cancer" was a call to action for the identification of novel reliable predictive biomarkers to ICPis that might drive more rationally the therapeutic decision making in lung cancer. The clinical and scientific relevance of the topic is further highlighted by the success of this Research Topic with 19 published papers, including 9 original research papers, 5 systematic reviews, 3 literature reviews, and 2 case reports.More than 130 authors contributed to this Research Topic, from several different countries.Circulating biomarkers are particularly appealing in this context, due to their minimally invasive nature and, in some cases, the low cost for their evaluation, as for example derived neutrophil-tolymphocyte (dNLR) ratio, lactate dehydrogenase (LDH), or the Lung Immune Prognostic Index (LIPI) score. Their prognostic value is well-known (7) and was further explored in some of the research studies presented here, including largely underexplored settings, such as SCLC. In addition to the prognostic value of these circulating biomarkers, others have explored the potential use as serial assessments of lab results, such as absolute lymphocyte count, or the correlation with immune suppressive circulating cytokine levels.Growing evidence suggest a pivotal role of microbiome in ICPis response within solid tumors, including lung cancer, and might be influenced by concomitant therapies, such as antibiotics or proton-pump inhibitors (PPIs). 8 Microbiome represents a potential therapeutic target in patients treated with ICPis and fecal transplantation has been reported to potential impact their therapeutic efficacy. 9 Overall, the Research Topic gathers part of the huge effort made in the last few years in understanding ICPis response in lung cancer, adding another piece to the complex puzzle of immunotherapy effects in solid tumors. The articles included in this Research Topic reflect the rapidly progressing field, moving beyond the conventional PD-L1-centric model toward a more comprehensive view of the complex interactions between immune system and lung cancer. Future challenges will be to combine and integrate several layers of information, from tumor genomics and transcriptomics, liquid biopsies, tumor microenvironment and microbiome (Fig. 1), and validate them in prospective studies.
Source: Frontiers in Immunology
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223067728