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NSCLC — SCE Medical Oncology MCQ

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HardLung CancerNSCLCSCE Medical Oncology

A patient has unresectable stage III NSCLC with tumour-cell PD-L1 expression 5%. Disease has not progressed six weeks after concurrent platinum-based chemoradiotherapy. Which consolidation treatment is NICE recommended?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Durvalumab consolidation after chemoradiotherapy for a maximum of twelve months

Explanation lettering: E = shown as B · B = shown as D · D = shown as E

D is correct. NICE TA798 recommends durvalumab for adults with unresectable locally advanced NSCLC whose disease has not progressed after concurrent platinum chemoradiation and whose tumour cells express PD-L1 at least 1%. Five per cent meets the threshold, and treatment is given for up to 12 months according to the regimen. Surveillance alone forfeits an indicated survival-improving treatment, pembrolizumab and nivolumab are not interchangeable NICE-appraised consolidation regimens here, and maintenance pemetrexed has no established role. The UK threshold is 1%, not 50%, which is important when interpreting PACIFIC data and commissioning.

Reference: NICE TA798 durvalumab maintenance recommendations: https://www.nice.org.uk/guidance/ta798/chapter/1-Recommendations