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NSCLC — SCE Medical Oncology MCQ

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HardLung CancerNSCLCSCE Medical Oncology

A 60-year-old renal transplant recipient with stage IV NSCLC (PD-L1 TPS 40%, wild-type) is being considered for first-line therapy. Why is immunotherapy relatively contraindicated?

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Correct answer: B — ICI carries ~30-40% risk of graft rejection in transplant recipients

Organ transplant recipients have ~30-40% graft rejection rate on ICI. Checkpoint inhibitors are relatively contraindicated. Platinum doublet chemotherapy without ICI is the appropriate approach.

Reference: ESMO 2024 NSCLC and Immunotherapy Guidelines; Abdel-Wahab et al Ann Oncol 2019