Drs sands_jacob and StephenVLiu discuss immunotherapy, biomarkers, next-generation sequencing, shared decision-making, and improving outcomes in the treatment of NSCLC. OncTwitter
plus chemotherapy, and other regimens coming up around the bend. For me, I'm looking at PD-L1 status. I'm looking at burden of disease and comorbidities. If the patients are very fit, I'm more likely to give chemotherapy upfront, especially if there's a large burden of disease. If someone's asymptomatic with PD-L1–high lung cancer, my preference is still monotherapy, and I like to avoid the chemotherapy toxicity. I'm probably using pembrolizumab there alone.
With regard to time and duration of treatment for each of these, do you do 2 years and stop? Are you doing any kind of assessment at that time? Is it patient to patient? What duration of therapy are you giving when it is effective and well tolerated?I'm highly conflicted here. It's certainly debatable when we think of duration of treatment. There's really only one randomized study that looked at this question, which wasled by Dave Spigel.
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