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Metastatic NSCLC with high PD-L1 — SCE Respiratory MCQ

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HardLung cancerMetastatic NSCLC with high PD-L1SCE Respiratory

A 64-year-old man with metastatic non-squamous NSCLC has no EGFR, ALK, ROS1, BRAF, MET or RET alteration identified. PD-L1 tumour proportion score is 85%, performance status is 0 and autoimmune screening history is negative. He has liver metastases but bilirubin and transaminases are within normal range. He asks about first-line systemic therapy. What is the most appropriate management?

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Correct answer: B — Pembrolizumab-based immunotherapy pathway

High PD-L1 metastatic NSCLC without a targetable mutation is typically managed with an immunotherapy-based first-line pathway, depending on histology and commissioning details. EGFR or ALK targeted therapy is inappropriate when molecular testing is negative. The crucial step is completing broad molecular testing before committing to systemic treatment.

Reference: NICE NG122 Lung cancer; NICE immunotherapy technology appraisals