Oncology Brothers: Practice-Changing Cancer Discussions How to Treat Metastatic Non-Small Cell Lung Cancer (NSCLC) Without Targeted Mutations
May 12, 2025
Dr. Mark Awad, a thoracic medical oncologist from Memorial Sloan Kettering, joins the discussion on treating metastatic non-small cell lung cancer (NSCLC) without actionable mutations. He highlights the significance of next-generation sequencing and PD-L1 levels in treatment decisions. Insights into current options for patients with varying PD-L1 scores are shared, detailing single-agent immunotherapy and chemotherapy combinations. Dr. Awad also delves into second-line treatment options and the evolving landscape of targeted therapies, stressing the need for ongoing clinical trials.
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PD-L1's Role in Treatment Choice
- PD-L1 tumor proportion score (TPS) is crucial in treatment decisions for metastatic NSCLC without actionable mutations.
- High PD-L1 (50%+) patients often respond well to single-agent immunotherapy, sparing chemotherapy toxicity.
Frontline Treatment Strategy Guidance
- Start single-agent PD-1 therapy for patients with high PD-L1 and good performance status.
- Add chemotherapy if disease burden or CNS metastases raise concern for rapid progression.
Chemo + Immunotherapy for Low PD-L1
- Chemo plus immunotherapy is favored over immunotherapy alone for PD-L1 1-49% patients.
- Evidence for benefit of dual checkpoint inhibition lacks prospective trials and remains debated.