Dr. Kosteva on Single-Agent Versus Combination Immunotherapy in NSCLC

John A. Kosteva, MD
Published: Thursday, Jul 05, 2018



John A. Kosteva, MD, clinical assistant professor of medicine, University of Pennsylvania School of Medicine, Abramson Cancer Center, discusses the adoption of immunotherapy into the treatment paradigm for patients with non–small cell lung cancer (NSCLC).

Right now, PD-L1 is still the best test physicians have to decide whether to administer single-agent immunotherapy or combination immunotherapy, says Kosteva. If a patient has PD-L1 expression greater than 50% and are eligible for frontline single-agent pembrolizumab, physicians should look at their disease burden to see how symptomatic they are.

The patients with symptomatic disease and high tumor mutational burden are the patients who need a high response rate with frontline treatment. These patients should receive triplet therapy with pembrolizumab (Keytruda) and standard chemotherapy, says Kosteva.

Physicians may be more inclined to use single-agent pembrolizumab in patients with pretty indolent disease. These would be the patients who are not very symptomatic, they have more [of an] incidental low tumor mutational burden, and other comorbidities. Additionally, they may be older, so there may be concerns about the side effects of chemotherapy.


John A. Kosteva, MD, clinical assistant professor of medicine, University of Pennsylvania School of Medicine, Abramson Cancer Center, discusses the adoption of immunotherapy into the treatment paradigm for patients with non–small cell lung cancer (NSCLC).

Right now, PD-L1 is still the best test physicians have to decide whether to administer single-agent immunotherapy or combination immunotherapy, says Kosteva. If a patient has PD-L1 expression greater than 50% and are eligible for frontline single-agent pembrolizumab, physicians should look at their disease burden to see how symptomatic they are.

The patients with symptomatic disease and high tumor mutational burden are the patients who need a high response rate with frontline treatment. These patients should receive triplet therapy with pembrolizumab (Keytruda) and standard chemotherapy, says Kosteva.

Physicians may be more inclined to use single-agent pembrolizumab in patients with pretty indolent disease. These would be the patients who are not very symptomatic, they have more [of an] incidental low tumor mutational burden, and other comorbidities. Additionally, they may be older, so there may be concerns about the side effects of chemotherapy.

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