Amishi Desai, MD
When choosing the best treatment for patients with metastatic stage IV non–small cell lung cancer (NSCLC), all decisions should be dependent on PD-L1 status, said Amishi Desai, MD.
Over the past few years, the introduction of immunotherapy has revolutionized the treatment of patients with NSCLC. For example, the PD-1 inhibitor pembrolizumab (Keytruda) has gained regulatory approval in the first- and second-line settings, and most recently, in December 2018, the FDA approved atezolizumab (Tecentriq) for use in combination with bevacizumab (Avastin), carboplatin, and paclitaxel for the first-line treatment of patients with metastatic nonsquamous NSCLC, though PD-L1 expression is not a requirement.
Nivolumab (Opdivo) and atezolizumab are also available in the second-line setting. Although deemed an imperfect biomarker, PD-L1 expression is used as a tool for clinical decision making to determine use of these agents in patients with NSCLC. Data emerging from recent trials are being used to inform treatment decisions as well, according to Desai, who is an assistant professor of medicine at Upstate University Hospital. When deciding on a treatment regimen, patients are divided into 3 groups: those with PD-L1 ≥50%, <50%, and <1%, Desai said.
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