Dr. Levy on First-Line Treatment for Nondriver NSCLC

Benjamin P. Levy, MD, assistant professor of oncology, clinical director of Medical Oncology, Sidney Kimmel Cancer Center and Johns Hopkins Medicine, discusses first-line treatment for patients with nondriver non—small cell lung cancer.

About 50% of patients in Levy’s practice do not have drivers that can be given targeted therapy. If patients are not being considered for a clinical trial, Levy’s first-line choice for patients with adenocarcinoma of the lung or squamous cell lung cancer and without an oncogenic driver is usually chemotherapy with immunotherapy. Patients with squamous cell disease, on the other hand, are generally not tested for genomic alterations, especially if they have a smoking history, says Levy.

Patients eligible for immunotherapy, typically given in combination with chemotherapy, are tested for PD-L1 expression. Patients with PD-L1 expression >50% and without an actionable mutation have the option of single-agent immunotherapy or a combination of platinum doublet with immunotherapy, concludes Levy.