Predictive genetic biomarkers in immune checkpoint inhibitors for non-small-cell lung cancer

Plain language summary Currently, immunotherapy based on immune checkpoint inhibitors represents a crucial tool in the treatment of non-small-cell lung cancer, but not all patients have an adequate response to this therapy, which is not free of side effects and may be difficult to access due to the costs involved; therefore, understanding who will benefit most from this therapy is essential. The biomarker most available nowadays (PD-L1 expression) is surrounded by limitations. An understanding of tumor genetics, in turn, represents a path with great potential to assist in patient selection, which is possible through assessing genomic peculiarities of the tumor. Tweetable abstract PD-L1 expression is not enough to predict which patients with advanced non-small-cell lung cancer will benefit most from immune checkpoint inhibitors. For this reason, the tumor genetic profile and its microenvironment represent potential tools for applicability in the future #Immunotherapy #PatientSelection. Immune checkpoint inhibitors improved the overall survival of patients with advanced non-small-cell lung cancer and changed the treatment since the last decade. The duration of response is longer than what is seen with chemotherapy or targeted agents; however, some patients have no benefit or even a progressive disease as best response. Immune checkpoint inhibitor plus chemotherapy combinations are a very useful strategy, but defining precisely who will benefit most from immunotherapy is still a main question. Therefore, understanding the genetics of the tumor microenvironment is a way to determine new predictive biomarkers to replace the only one currently accepted, PD-L1 expression, whose application is surrounded by uncertainties.