How do you decide which immunotherapy agent to utilize for 1st line in PD-L1 high (>50%) NSCLC?  

Now with the approval of atezolizumab based on the positive Impower110 study (led by @David R. Spigel and @Roy S. Herbst), we have 2 frontline checkpoint inhibitors to choose from. Indeed the data appears very convincing for both, therefore on scientific grounds, I would not be able to choose one ve...

For PD-L1 high NSCLC that lacks an actionable driver, we have multiple options. For someone who is asymptomatic, monotherapy with a PD-1 or PD-L1 inhibitor is very reasonable. For someone with symptoms or where response is critical (due to anatomic location of disease), combinations with chemotherap...

For me, it is a matter of comfort. Both atezolizumab and pembrolizumab are appropriate to utilize in this situation. Both of those agents appear to have similar efficacy, so both are equally appropriate to use. Pembrolizumab was first approved for this indication and I am using it for my patients wi...

Pembrolizumab is our standard. It has the best data, and it is on our pathway. We’ve not migrated to atezolizumab. I am not convinced it offers any advantage over pembrolizumab. 

It really comes down to pembrolizumab, atezolizumab, and most recently, cemiplimab - at least in the US. I suspect there are minimal clinical differences between these agents - and it comes down to comfort, routine, and - more often - clinical pathways for a center. 

With the option to go for 6 weekly dose, I favor using pembrolizumab. If high tumor burden causing symptoms or risk of organ compromise, will add chemotherapy for at least 2-4 cycles.

Pembrolizumab single agent therapy.

How about the FDA doing its job and requiring a head to head trial vs the current standard of care before approving a drug. Show that the new drug is more effective, less toxic, cheaper, etc or it doesn't get approved!