Not only is immunotherapy currently not recommended for patients with mutations in genes such as EGFR and ALK, but it is also not a good option after failure of targeted therapy in such patients. Some studies have found that using immunotherapy after failure of targeted therapy is not only ineffective, but may also carry the risk of tumor progression (Hyper Progressive Disease (HPD)).
According to the 2018 edition of the Chinese Society of Clinical Oncology (CSCO) Guidelines for the Management of Primary Lung Cancer, patients with NSCLC who have genetic mutations should first be tested for resistance mutations after failure of targeted therapy, and new targeted agents should be selected based on the resistance mutations. If no resistance mutations are detected, then single-agent chemotherapy is recommended for patients with EGFR mutations, and platinum-containing two-agent chemotherapy is recommended for patients with ALK mutations.
Co-reviewed by: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Institute Dr. Wang Zhen, deputy chief physician Zhang Chao