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Thoracic Malignancies • Medical Oncology
How do you proceed with treatment of a patient with stage IIIB NSCLC who progresses DURING treatment with concurrent weekly carboplatin/paclitaxel and radiation?
Assuming no clinical trial, no actionable mutation, and PD-L1 < 50%, do you consider the patient to be primary refractory to platinum and move to single agent immunotherapy or would you consider chemoimmunotherapy vs nivo/ipi?
Answer from: Medical Oncologist at Academic Institution
I have been looking at this question for a little over a week, and struggling to know how to answer this. The relevant trials for a patient with PDL1 somewhere between 0 and 49% (KEYNOTE-189, KEYNOTE-407, KEYNOTE-042, CheckMate 227, and 9LA) would have excluded patients who received either adjuvant ...
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Answer from: Medical Oncologist at Community Practice
This is a low platinum dose. I would most likely switch to chemo and immunotherapy. I would be concerned about pneumonitis with a combined immunotherapy approach initially with the near use of radiation. If after 2 cycles the response is unsatisfactory, one could try then an ipi, nivo approach.