Dr. Sequist on Pembrolizumab Monotherapy in Nonsquamous NSCLC

Lecia V. Sequist, MD, MPH, the Landry Family Associate Professor of Medicine at Harvard Medical School, and director, Center for Innovation in Early Cancer Detection, Massachusetts General Hospital, discusses the use of pembrolizumab (Keytruda) monotherapy versus the combination of pembrolizumab and chemotherapy in advanced nonsquamous non—small cell lung cancer (NSCLC).

When a patient with advanced nonsquamous NSCLC presents in the clinic with a PD-L1 expression higher than 50%, the decision of whether to pursue pembrolizumab monotherapy or combination chemoimmunotherapy should be done on an individualized basis. If the patient is highly symptomatic, and a faster response is needed, the combination of chemotherapy and immunotherapy is likely the better option, as this approach has shown higher response rates compared with pembrolizumab monotherapy, explains Sequist.

Conversely, if a patient with high PD-L1 expression is not fit enough to receive a triplet regimen due to mild renal insufficiency or borderline performance status, immunotherapy alone is the optimal choice, as high PD-L1 expression is indicative of benefit from single-agent pembrolizumab.