Best first line regime for advanced NSCLC without driver mutation
Dr Ahn Myung-Ju, Samsung Medical Center, Sungkyunkwan University School of Medicine

The treatment landscape of advanced NSCLC without oncogenic driver has been rapidly evolving with immune checkpoint inhibitors (ICI). Currently, advanced NSCLC patients without oncogenic driver regardless of histology should be tested for PD-L1 expression at diagnosis. In patients with high expression of PD-1 > 50%, ICI monotherapy such as pembrolizumab, atezolizumab, or cemiplimab is recommended, but chemotherapy with ICI is also recommended. In case of PDL1 0 or 1--49%, chemotherapy with ICI combination is recommended. These include pembrolizumab + platinum-pemetrexed, atezolizumab + carboplatin+ pactlitaxel + bevacizumab or atezolizumab + carboplatin + paclitaxel for non-squamous cell carcinoma, pembrolizumab + platinum + paclitaxel for squamous cell carcinoma. Regardless of PDL1 status, nivolumab plus ipilimumab, nivolumab + ipilimumab + 2 cycles of platinum doublets or durvalumab +tremeliumab + platinum doublet chemotherapy is also recommended for all histology. However, given the limitation of head to head comparison among different trials, several issues should be taken into consideration for choosing the best first line regimen and will be discussed during the presentation. Although tremendous improvement of overall survival with ICIs, there is more room for improvement. Lots of effort with novel agents or combinational approach have been made which will be discussed.