Personalized Selection of Immunotherapy Strategies in Metastatic NSCLC and Future Evidence Gaps

In Personalized Selection of Immunotherapy Strategies in Metastatic NSCLC and Future Evidence Gaps, our experts delve into the following critical questions:

We have now covered several treatment approaches for patients with metastatic NSCLC. Based on the data discussed, how are you determining which patients receive a. dual immunotherapies, b. single immunotherapy, and c. immunotherapy with chemotherapy?

Beyond the data covered today, is there any additional data with immunotherapies in metastatic NSCLC that you would like to see?

Led by the Dr. Dietrich, Drs. Niu and Nadler discuss selection of immunotherapy strategies in metastatic NSCLC, which is guided by tumor characteristics, biomarker status, patient performance status, comorbidities, and prior treatments. Patients with high PD-L1 expression and no targetable driver mutations may benefit from single-agent immunotherapy, providing durable responses with a favorable toxicity profile. Dual immunotherapy regimens, such as nivolumab plus ipilimumab, are considered for patients who can tolerate potential immune-related toxicities and who may benefit from chemotherapy-sparing approaches or longer-term disease control. For patients with low or negative PD-L1 expression, high tumor burden, or rapidly progressing disease, combining immunotherapy with chemotherapy offers rapid disease control while leveraging the durability of immune checkpoint inhibition.

Additional factors influencing therapy choice include histology, organ function, and patient preference, emphasizing the importance of a multidisciplinary approach. Clinicians also consider safety profiles, monitoring requirements, and patient tolerance to prior therapies when selecting a regimen. Looking forward, there is interest in further data to refine patient selection, optimize sequencing of immunotherapy combinations, and evaluate emerging biomarkers beyond PD-L1 that could better predict response and toxicity. Ongoing trials and real-world evidence will help clarify these questions and support more personalized treatment strategies in metastatic NSCLC.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

Our next episode, Optimizing Subcutaneous Therapies in NSCLC: Practical Integration, Patient Selection, and Workflow Considerations, the lung cancer experts examine the different routes of administration for immunotherapies.