Dr. Socinski on Immunotherapy Approaches in Squamous NSCLC

Mark A. Socinski, MD
Published: Tuesday, Jan 29, 2019



Mark A. Socinski, MD, executive medical director, AdventHealth Medical Group, discusses combination versus single-agent immunotherapy in the treatment of patients with squamous non–small cell lung cancer (NSCLC).

Results from the KEYNOTE-024 study suggested that single-agent pembrolizumab (Keytruda) was superior to standard chemotherapy for the frontline treatment of patients with metastatic NSCLC who had PD-L1 expression ≥ 50%. However, in that study, only 19% of patients had squamous carcinoma, Socinski notes. It is also not entirely clear if the patients with squamous disease had the same survival benefit as the nonsquamous patients, he adds.

If one looks at the data, it seems pretty clear that in the patients with < 50% PD-L1 expression, pembrolizumab monotherapy is not an option, Socinski says; rather, these patients should receive immunotherapy with chemotherapy.

Furthermore, Socinski says that even in his patients with squamous NSCLC who have PD-L1 expression ≥ 50%, he typically uses combination chemotherapy and immunotherapy. Due to the small number of patients in the KEYNOTE-024 study, physicians should err on the side of caution with single-agent pembrolizumab and focus on controlling the disease in their patients. Currently, the best way to achieve control of the disease in the squamous population is with chemotherapy plus immunotherapy, he says.
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Mark A. Socinski, MD, executive medical director, AdventHealth Medical Group, discusses combination versus single-agent immunotherapy in the treatment of patients with squamous non–small cell lung cancer (NSCLC).

Results from the KEYNOTE-024 study suggested that single-agent pembrolizumab (Keytruda) was superior to standard chemotherapy for the frontline treatment of patients with metastatic NSCLC who had PD-L1 expression ≥ 50%. However, in that study, only 19% of patients had squamous carcinoma, Socinski notes. It is also not entirely clear if the patients with squamous disease had the same survival benefit as the nonsquamous patients, he adds.

If one looks at the data, it seems pretty clear that in the patients with < 50% PD-L1 expression, pembrolizumab monotherapy is not an option, Socinski says; rather, these patients should receive immunotherapy with chemotherapy.

Furthermore, Socinski says that even in his patients with squamous NSCLC who have PD-L1 expression ≥ 50%, he typically uses combination chemotherapy and immunotherapy. Due to the small number of patients in the KEYNOTE-024 study, physicians should err on the side of caution with single-agent pembrolizumab and focus on controlling the disease in their patients. Currently, the best way to achieve control of the disease in the squamous population is with chemotherapy plus immunotherapy, he says.

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Online CME Activities
TitleExpiration DateCME Credits
Community Practice Connections™: New Directions in Advanced Cutaneous Squamous Cell Carcinoma: Emerging Evidence of ImmunotherapyAug 13, 20191.5
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