Treatment of Advanced or Metastatic NSCLC with PD-L1 Expression <1% and No Actionable Driver Mutation

This protocol addresses patients with advanced or metastatic non-small cell lung cancer (NSCLC) in whom PD-L1 expression is below 1% and no actionable driver mutation has been identified — a population with specific treatment considerations across lines of therapy.

Clinical Scenario

Advanced or metastatic NSCLC — PD-L1 expression less than 1% — no actionable driver mutation detected. This molecular profile defines the patient population for which this protocol is designed.

Treatment Approach — Partial Overview

When disease progresses on initial therapy, subsequent treatment options include specific chemotherapy agents, with selection informed by histological subtype. There is an important restriction on the use of checkpoint inhibitor therapy in this setting following prior progression on a PD-1/PD-L1 inhibitor.

Complete regimen, sequencing, and eligibility criteria available via the full protocol.
Instant Access to Structured Evidence-Based Regimens

References

Combination therapy with pembrolizumab plus chemotherapy is recommended (category 1; preferred) as a first-line therapy option in eligible patients with metastatic NSCLC and negative test results for actionable driver mutations, regardless of PD-L1 expression levels.

If patients have disease progression on PD-1/PD-L1 inhibitor therapy (± chemotherapy), then using a PD-1/PD-L1 inhibitor is not recommended for subsequent therapy.

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