Expanding horizons in lung cancer immunotherapy

Immunotherapy continues to transform the management of non-small cell lung cancer (NSCLC), offering the prospect of long-term survival even to patients at advanced stages of the disease. According to data presented at the 29th Russian Oncology Congress, one in four patients (27.8%) with metastatic squamous NSCLC remains alive five years after initiation of camrelizumab-based chemoimmunotherapy^[1].

Experts emphasized that the advent of checkpoint inhibitors has fundamentally reshaped the treatment paradigm for advanced lung cancer. Today, one of these agents — camrelizumab — has become available to Russian patients.

Lung cancer remains one of the most devastating cancers in Russia. Each year, more than 50,000 new cases are diagnosed, with 69.5% of patients identified at stages III–IV^[2]. Globally, lung cancer ranks first in incidence and mortality among malignant neoplasms^[3], and prognosis remains poor. In Russia, almost half of patients (44.3%) die within the first year after diagnosis^[2].

Efficacy of camrelizumab was confirmed in the CAMELsq study, where adding the agent to first-line treatment in patients with squamous NSCLC resulted in an overall survival benefit across all subgroups, regardless of PD-L1 expression level^[1]. Notably, 84% of patients who completed a full two-year course of treatment surpassed the five-year survival threshold, allowing lung cancer in these cases to be viewed not as a fatal disease, but as a potentially chronic condition^[1],[5].

On 9 December, the Ministry of Health of the Russian Federation approved a new indication for Areima^® (camrelizumab) as first-line treatment for NSCLC. In addition to the squamous histological subtype, the indication also includes lung adenocarcinoma^[4].

Camrelizumab mode of action is particularly interesting at the molecular level. In addition to PD-1 blockade, the antibody can bind to ULBP2, a protein involved in regulating natural killer (NK) cell activity. This effect enhances antitumor immune responses and reduces dependence of clinical outcomes on PD-L1 expression levels^{[7],[8],[9],[10]}.

Camrelizumab is also actively used and studied in esophageal cancer, one of the most aggressive malignancies, ranking seventh worldwide in cancer-related mortality^[13]. In Russia, approximately 7,200 new cases of esophageal cancer are diagnosed annually, with more than 60% detected at stages III–IV^[2].

The ESCORT-1st study demonstrated that adding camrelizumab to first-line chemotherapy for locally advanced or metastatic squamous cell esophageal cancer doubles three-year overall survival compared with standard chemotherapy alone^[14].

To date, camrelizumab is being investigated in more than 400 clinical trials worldwide for the treatment of various malignancies, including nasopharyngeal carcinoma, esophageal, gastric, hepatic, and lung cancers, among others^[15]. Mounting evidence supports further expansion of indications, opening new therapeutic opportunities for Russian physicians and patients.