First-Line Treatment of Advanced or Metastatic NSCLC with PD-L1 Expression 1%–49% and No Driver Mutation
Clinical Scenario
This protocol applies to patients with advanced or metastatic non-small cell lung cancer (NSCLC) whose tumours show PD-L1 expression in the range of 1% to 49% and who have tested negative for actionable driver mutations. This intermediate PD-L1 level distinguishes the population from both PD-L1-high and PD-L1-negative disease and informs the choice of first-line systemic therapy.
Key Qualifying Criteria
Confirmed advanced or metastatic stage; PD-L1 tumour proportion score 1%–49%; absence of actionable driver mutations on molecular testing. Histological subtype (nonsquamous vs. squamous) influences the specific regimen selected within this setting.
Treatment Approach (Partial Overview)
First-line management in this setting incorporates immunotherapy combined with platinum-based chemotherapy as the preferred approach, alongside a single-agent immunotherapy option applicable under certain circumstances. The complete regimen selection — including agent combinations, sequencing, and maintenance strategy — is available in the full protocol.
Full regimen details, criteria, and maintenance guidance accessible below →
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.
- The NCCN NSCLC Panel recommends single-agent pembrolizumab as a first-line therapy option in eligible patients with metastatic NSCLC regardless of histology, PD-L1 levels of 1% to 49% (category 2B; useful in certain circumstances), and negative test results for actionable driver mutations.
View source ↗