How do you approach duration of immunotherapy in patients with metastatic NSCLC?

If someone manages to continue the ICI maintenance up to 2 years without progression, I am comfortable counseling the patient to stop the ICI treatment as per the regulatory approval indication. I have had occasionally, patient's anxiety level driving the desire to continue beyond the 2 years treatment duration which we were able to get approval to do so, fortunately; but eventually patient requested to come off of it, as it is still impactful on their QOL and effort in returning Q3-6 weeks for the ICI infusion and labs for extended period of time.

For patients I have who underwent ablative/consolidative local XRT/SBRT on progressive lesions on maintenance ICI treatment, I continue ICI treatment after XRT/SBRT completion with a reset of 2 y...

In patients with metastatic NSCLC on immunotherapy without progression at 2 years, I discuss with patients the option of stopping immunotherapy vs continuing it, and then we make a mutual decision in this regard. This is guided by this retrospective review from 2023.

Sun et al., PMID 37270700