Dr. Villaruz on Selecting Between Single-Agent and Combination Immunotherapy in NSCLC

Liza C. Villaruz, MD, associate professor of medicine, medical oncologist, Division of Hematology/Oncology, UPMC Hillman Cancer Center, discusses selecting between single-agent and combination immunotherapy in non–small cell lung cancer (NSCLC).

Several single-agent and combination immunotherapy regimens, such as nivolumab (Opdivo) plus ipilimumab (Yervoy), are approved for use in patients with NSCLC based on PD-L1 status, Villaruz explains. Additionally, some chemoimmunotherapy combinations are approved irrespective of PD-L1 status.

Patients with PD-L1–high NSCLC by tumor proportion score (TPS) of 50% or higher are typically treated with single-agent immunotherapy with pembrolizumab (Keytruda) or cemiplimab-rwlc (Libtayo), Villaruz says. Although single-agent pembrolizumab is also approved for patients with PD-L1 TPS of 1% or greater, it is important to note that this group has more variable responses to single-agent immunotherapy that are not as pronounced compared with those in the PD-L1–high population.

As such, patients with a PD-L1 status of 1% to 49% should be considered for combination chemoimmunotherapy. For symptom control, chemoimmunotherapy should also be considered for patients with PD-L1–high NSCLC who have significant tumor burden to potentially elicit an early cytoreductive effect, Villaruz concludes.