What are the guidelines for PD-1/PD-L1 inhibitors for treatment of metastatic (stage IV) non-small cell lung cancer (NSCLC)?

Updated: Jul 15, 2021
  • Author: Marvaretta M Stevenson, MD; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Answer

Answer

Pembrolizumab is indicated as first-line monotherapy for patients with stage III NSCLC who are not candidates for surgical resection or definitive chemoradiation, or metastatic NSCLC, and whose tumors express PD-L1 (TPS ≥1%) with no EGFR or ALK genomic tumor aberrations. Pembrolizumab is also indicated after platinum-containing chemotherapy for tumors that express PD-L1 (TPS ≥1%). Patients with EGFR or ALK aberrations should have disease progression on US Food and Drug Administration (FDA)–approved therapy for those aberrations before receiving pembrolizumab; dose as follows: [47, 68, 48]

  • Pembrolizumab 200 mg IV q3wk or 400 mg IV q6wk; continue until disease progression or unacceptable toxicity (for up to 24 mo)

Atezolizumab is indicated as first-line treatment of adult patients with metastatic NSCLC whose tumors have high PD-L1 expression (PD-L1 stained ≥50% of tumor cells [TC ≥50%] or PD-L1–stained tumor-infiltrating immune cells [IC] covering ≥10% of the tumor area [IC ≥ 10%]), as determined by an FDA-approved test, with no EGFR or ALK genomic tumor aberrations:

  • Atezolizumab 840 mg IV q2wk, 1200 mg IV q3wk, or 1680 mg IV q4wk until disease progression or unacceptable toxicity [69]

Cemiplimab has accelerated approval for first-line treatment of NSCLC who tumors have high PD-L1 expression [TPS ≥50%] with no EGFR, ROS-1, or ALK mutations:

  • Cemiplimab 350 mg IV q3wk until disease progression or unacceptable toxicity [70]

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