Does the final report and approval of CHECKMATE 227 (ipi/nivo) regimen change your first line recommendations for patients with PDL1 TPS < 1%?  

Not at this point. There are many factors that should be considered when treating patients with a PD-L1 < 1%. A recent analysis (page 372, MA25.01) of KEYNOTE 407, 021, and 189 indicated that patients receiving chemotherapy + pembrolizumab had improved survival compared to those receiving chemoth...

I agree With Dr.@Nasser H. Hanna - I think these results however beg the question of a comparison trial between Nivo/Ipi and chemo/Pembro (in various strata - PDL1 0, PDL1 1-49%, and PDl1 > 50%). 

Use of nivo/ipi would be off label and my board answer is still any of the chemo/IO combinations with pembro or atezo. But the 2 year OS rate of 40% in the PD-L1 < 1% subset was impressive and the duration of response with this combination is hard to ignore. We will see the 3-year follow up at AS...