Four of the five PD-1/PD-L1 inhibitors currently approved for NSCLC treatment are Nivolumab, Pembrolizumab, Atezolizumab, and Durvalumab.
The indication for first-line use of Pembrolizumab requires that NSCLC patients have a Tumor Proportion Score (TPS) of no less than 50% (more than 50% of tumor cells express PD-L1) and no EGFR or ALK mutations; the indication for second-line use requires a TPS of no less than 1%, and for NSCLC carrying EGFR or ALK mutations should be considered for targeted therapy first.
Nivolumab and Atezolizumab are approved for second-line treatment of NSCLC, and their indications clearly state that targeted therapy should be considered first over PD-1/PD-L1 inhibitors for NSCLC with EGFR or ALK mutations.
Durvalumab is approved for consolidation therapy in patients with stage III NSCLC who have not progressed after concurrent radiotherapy.
According to the instructions, before using PD-1/PD-L1 inhibitors, testing for mutations in driver genes targeted by current targeted therapy, such as EGFR, ALK, etc., is required, and patients with mutations for which PD-1/PD-L1 inhibitor therapy is not effective should still choose targeted therapy.
Co-reviewed by: Guangdong Provincial People’s Hospital Guangdong Provincial Lung Cancer Institute Dr. Wang Zhen, Deputy Chief Physician Peng Xiaoxiao