How would you treat a metastatic lung adenocarcinoma with MET exon 14 skip mutation on ctDNA, negative tissue NGS and PD-L1 of >50%?

Topics: Thoracic Malignancies • Medical Oncology • NCI-CCC Tumor Board Question • Ohio State University

The NCCN guidelines regard MET exon 14 skip mutation as an emerging biomarker but no formal recommendation to start crizotinib. If high PD-L1 and unclear if this driver mutation decreases IO effectiveness, what upfront treatment would you recommend?

Answer from: Medical Oncologist at Academic Institution

I would treat this patient with single-agent pembrolizumab. If they had rapidly progressing disease with worsening symptoms or if they were a never smoker, I would favor carboplatin/pemetrexed/pembrolizumab in order to optimize rapidity of response. These recommendations are based on the results of ...

Comments

Medical Oncologist at Monument Health Cancer Care Institute
If the PDL1 was low and the patient symptomatic or...

Medical Oncologist at Central Cancer Care
We don't use single agent pembrolizumab frontline ...

Medical Oncologist at University of Michigan Medical School
See point #3 in my original answer. EGFR, ALK, and...

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