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The landmark CheckMate 017 (for squamous) and CheckMate 057 (for nonsquamous) advanced NSCLC randomized phase III trials set PD-1 inhibitor immunotherapy over chemotherapy as the standard of care for subsequent systemic therapy (current NCCN category 1 guideline recommendation). A recent continued to demonstrate improved overall survival (five-fold) and progression-free survival with lower adverse events on nivolumab versus docetaxel.

What remains difficult implementing this data is the increased use of immunotherapy in earlier settings, both front-line (e.g., KEYNOTE-021/024/042/189/407, CheckMate-227/9LA, and Impower 110/130/150 trials) and adjuvant (e.g., PACIFIC trial).

At this time, switching to a subsequent PD-1/PD-L1 inhibitor is not recommended. An anticipated persistent space for subsequent-line immunotherapy is limited: a less fit (ECOG PS 2) patient, PD-L1 <1%, without molecular target, without a contraindication to immunotherapy, and who did not receive a PD-1/PD-L1 inhibitor as part of initial therapy.

Guidelines still consider chemotherapy alone in this setting, although this too is apt to change in years to come.

Essentially this updated pooled analysis bolsters that which we already knew: give immunotherapy for NSCLC, it works and for a long time!

Claire L. Hiles, MD, is a hematologist/oncologist at David Grant Medical Center at Travis AFB in California.

Read the study here and an interview about it here.