Dr. Qin on Selecting Single-Agent Immunotherapy or Chemoimmunotherapy in NSCLC

Angel Qin, MD, clinical assistant professor, University of Michigan Health, medical oncologist, Rogel Cancer Center, Michigan Medicine, discusses selecting between single-agent immunotherapy or combination chemoimmunotherapy in non–small cell lung cancer (NSCLC).

The PD-L1 expression level of a patient with NSCLC largely determines whether the patient should receive single-agent immunotherapy or combination chemoimmunotherapy, Qin explains. For example, patients with PD-L1 expression at least 50% can be considered for single-agent immunotherapy. However, if the patient has significant tumor burden or is on the verge of visceral crisis from disease burden, chemotherapy may be added to immunotherapy for cytotoxic reduction, Qin says. In these situations, the full course of chemotherapy may not be required, Qin adds.

For patients with PD-L1 expression between 1% and 49%, performance status guides treatment decisions, Qin says. Although single-agent pembrolizumab (Keytruda) is approved for use in this patient population, patients may not derive a sufficient response without chemotherapy. However, altering the treatment regimen to introduce histology-specific chemotherapy later after platinum-based chemotherapy and pembrolizumab may be beneficial for patients.

Additionally, some patients have strong aversions to chemotherapy, so single-agent pembrolizumab can be considered based on patient preference as well, Qin concludes.