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NSCLC — SCE Medical Oncology MCQ

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HardLung CancerNSCLCSCE Medical Oncology

A patient with untreated metastatic non-squamous NSCLC has PD-L1 TPS 70%, no EGFR or ALK alteration, ECOG 1 and no need for an immediate high-volume response. Which chemotherapy-free first-line option is NICE recommended?

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Correct answer: E — Pembrolizumab monotherapy for PD-L1-high driver-negative disease

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

C is correct. Pembrolizumab monotherapy is NICE recommended for untreated metastatic NSCLC with PD-L1 TPS at least 50% and no EGFR- or ALK-positive tumour. ECOG 1 matches the evidence base. Gefitinib requires sensitising EGFR mutation; carboplatin is not used alone as an effective NSCLC regimen; pemetrexed monotherapy is not the preferred first-line approach; and supportive care should accompany rather than replace appropriate active therapy. In symptomatic bulky disease, a chemo-immunotherapy combination may be preferred for response probability, so the absence of urgent tumour-burden pressure makes the monotherapy choice exclusive.

Reference: NICE TA531 pembrolizumab monotherapy in untreated PD-L1-positive NSCLC: https://www.nice.org.uk/guidance/ta531/chapter/1-Recommendations