How would you manage a patient with no driver mutation, PD-L1 <50%, with systemic relapse of lung adenocarcinoma within a year after resection and completion of adjuvant platinum based chemotherapy?   

I don’t think the addition of Bev as seen in the IMPOWER trial added much beyond the activity of the triplet therapy seen in KN 189, and if the patient retains a decent PS on progression, you can then use docetaxel/ramucirumab.

Usually, platinum resistance is defined by recurrence within 6 months of platinum based therapy. Thus, if the patient relapsed within 6 months of platinum based therapy, I will forego chemotherapy based on platinum agents. In such a situation, if PDL1 is >1%, pembrolizumab is approved as a single...