Community Oncologist

I have 59 M with Metastatic Squamous cell Lung cancer with PDL1 90%. plan to proceed with IO alone. Any preference among the 4 immunotherapy approvals for Squam ( Nivo/Ipi vs Pembro, Vs cemiplimab vs atezolizumab)?

Lung Cancer Specialist

That is a good question. In the checkmate 227 trial, patients with a PD-L1 > 50% or more, the 2-year overall survival rate was 48.1% and 41.9%, for nivolumab ipi vs nivolumab alone. As you pointed out Nivolumab isn't FDA approved in front line as a single agent. There are aggregate data suggesting that the higher the PDL1 score the better the outcomes for single agent immune check point inhibitors. That, with the improved tolerability, I would recommend single agent anti-PD1 therapy. For patients less than 60Kg, I often start with the pembrolizumab at the 2mg p kg dosing which is every 3 weeks. I believe pembrolizumab, atezolizumab and cemiplimab all have excellent data. The cemiplimab trial design did allow for continuation of cemiplimab with addition of platinum doublet upon progression.