Do we have any data on sequencing of up front therapies for patients with high PD-L1 and targeted mutations?

Topics: Thoracic Malignancies • Medical Oncology

First line pembrolizumab is only approved after progression on TKI - but would you ever offer chemo-immunotherapy prior to target therapy?

Answer from: Medical Oncologist at Academic Institution

Patients with EGFR and BRAF mutations or ALK and ROS1 fusions should receive 1st line approved TKI therapy and second line approved TKI therapy for EGFR and ALK. Checkpoint inhibitors should be used only after TKIs even if PD-L1 expression is high. For patients with PD-L1 expression >50%, it is n...

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Medical Oncologist at Saint Louise Regional Hospital
Would it be fair to say then that PDL1 expression ...

Answer from: Medical Oncologist at Community Practice

@Paul A. Bunn makes a very important point. I have seen at least 2 cases where patients were started on pembrolizumab because the tumor PD-L1 was high and then subsequently tumor was found to be EGFR mutation positive. As far as sequence of therapy, yes Osimertinib followed by chemothera...

Answer from: Medical Oncologist at Community Practice

One clarification on my previous comment- In IMPOWER150 patients with EGFR and ALK NSCLCs were only enrolled after treatment with TKIs.

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Medical Oncologist at Kaiser Permanente
I have a patient with both BRAF V600E mutation and...

Medical Oncologist at Cancer Care Specialists/Renown Oncology/UNR
BRAF mutation is one driver mutation where IO can ...

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