From the Guidelines
Pembrolizumab is considered a standard first-line option for patients with advanced non-small cell lung cancer (NSCLC) and high PD-L1 expression (≥50%) who do not have contraindications to immunotherapy, as it has been shown to improve overall survival and progression-free survival compared to chemotherapy alone 1.
Key Considerations
- PD-L1 testing should be performed on tumor tissue before starting treatment to guide therapy selection.
- Patients with high PD-L1 expression (≥50%) often respond better to immunotherapy drugs called immune checkpoint inhibitors.
- First-line treatment options for advanced NSCLC patients with high PD-L1 expression include pembrolizumab (Keytruda) as monotherapy at 200 mg IV every 3 weeks or 400 mg every 6 weeks, or combination regimens like pembrolizumab plus chemotherapy.
- For patients with PD-L1 expression between 1-49%, combination therapy with immunotherapy and chemotherapy is often recommended.
Immune-Related Adverse Events
- Common side effects of immunotherapy include fatigue, rash, and immune-related adverse events affecting organs like the thyroid, lungs, or liver.
- Regular monitoring for these side effects is essential during treatment.
Biomarkers
- PD-L1 expression level is widely used as an immune biomarker, but it is not an ideal biomarker because some patients with low PD-L1 expression levels respond to immunotherapy and others with high levels do not respond to immunotherapy.
- Tumor mutational burden (TMB) is another biomarker that has been assessed in clinical trials, but its utility in predicting response to immunotherapy is still being studied 1.
From the Research
PD-L1 Expression and Non-Small Cell Lung Cancer
- PD-L1 expression is a biomarker used to predict the response to immunotherapy in non-small cell lung cancer (NSCLC) patients 2, 3, 4, 5, 6
- Studies have shown that patients with high PD-L1 expression (≥50%) have improved outcomes with PD-1 inhibitor monotherapy compared to platinum-based chemotherapy 2, 5
- Very high PD-L1 expression (≥90%) has been associated with even better outcomes, including higher overall response rates and longer progression-free survival 2, 3
Treatment Options for NSCLC with High PD-L1 Expression
- Pembrolizumab monotherapy is a preferred treatment option for patients with advanced NSCLC and high PD-L1 expression 4, 6
- The addition of chemotherapy to pembrolizumab may further improve outcomes, including overall response rates and progression-free survival 4, 6
- Network meta-analyses have compared the efficacy of different PD-(L)1 inhibitors, including pembrolizumab, cemiplimab, and atezolizumab, in the first-line treatment of NSCLC with high PD-L1 expression 5
Patient Characteristics and Treatment Outcomes
- Patient characteristics, such as age and performance status, may influence treatment outcomes and the choice of treatment regimen 6
- Retrospective studies have reported varying treatment outcomes, including progression-free survival and objective response rates, in patients with NSCLC and high PD-L1 expression treated with pembrolizumab monotherapy or combination therapy 2, 3, 6