What is your preferred first line approach to patients with good PS stage IV non-squamous NSCLC that is EGFR/ROS1/ALK/BRAF WT and PDL-1 < 1%?

At least two phase III studies have now demonstrated the benefit of chemoimmunotherapy as first line therapy. The carboplatin/pemetrexed/pembroluzimab regimen, initially reported and FDA approved on the basis of a randomized phase II study has now been validated in the phase III setting (Keynote 189) . Effectiveness has been demonstrated regardless of PD-L1 status (though the magnitude of benefit is somewhat correlated with increased PD-L1 expression). I have personally used the regimen for the ...

I agree with @Dr. First Last's approach and the regimen(s) used. I tend to use pemetrexed and carboplatin as my "go to" regimen for non-squamous histology given its excellent tolerability, and use paclitaxel, carboplatin and bevacizumab generally for those not able to use pemetrexed (renal function most commonly). I similarly agree with the comment about the use of pembrolizumab combined with pemetrexed and carboplatin - seems quite active, with tolerable safety profile, however I have (had) bee...