How do you decide between checkpoint monotherapy versus chemo-immunotherapy approach for patients with PD-L1 High (>50%) NSCLC?  

At this point, there are no prospective trials comparing checkpoint monotherapy and chemo-immunotherapy for patients with PD-L1 high NSCLC. The ongoing prospective INSIGNA trial will answer this question. If one does a cross trial comparison of pembrolizumab for patients with PD-L1 of >50% and ch...

We do not have head-to-head comparison, but looking at the data overall, many of us favor single agent immunotherapy for stage IV NSCLC patients with PD-L1>=50% and without any sensitizing driver mutation. Various trials utilizing single agent IO (KN-024, IMpower-110, EMPower Lung) have demonstra...

Purely, a clinical decision at this point. I have equipoise comparing Pembrolizumab alone to Pembro combinations in this population. I introduce combination chemotherapy and pembrolizumab in more symptomatic patients with greater metastatic burden, who are fit enough to receive the combination. In t...

While now with new approvals based on CM227 and 9LA, we have a widening array of choices. For most patients with advanced NSCLC, the key choices are between single agent immunotherapy versus chemo/immunotherapy - the main research question addressed by the INSIGNA study amongst patients with PD-L1 p...

For patients who have a good performance status, I always discuss clinical trials for first-line therapy. INSIGNA EA5163/S1709 is a great option that will help to answer the key clinical question of whether use of chemotherapy can be spared or delayed for PDL1 positive for these patients. In additio...

I more often use chemo/IO here, because of the safety of the broader approach. I reserve monotherapy for those with a good PS and minimal symptoms. That is a minority of patients seen in the first-line.

In light of recent data showing IO-resistance in patients with mutations/comutations in STK11, KEAP1, TP53, and KRAS, I now favor IO-chemotherapy combinations for PDL-1 =>50% NSCLC patients with those molecular aberrations, if those mutations are not present, I use IO alone.