Would you consider first line therapy with PD-1 inhibitors (+/- CTLA4) for patients with metastatic NSCLC with high tumor mutational burden despite negative PD-L1?   

I would consider giving a patient with metastatic NSCLC and a high tumor mutational burden despite negative PD-L1 treatment with Nivolumab plus Ipilumumab. I would also consider giving the same patient chemotherapy plus a checkpoint inhibitor alone!The optimal treatment for this patient population ...