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June 27, 2017. In the CheckMate 026 trial published this week in NEJM, first-line nivolumab (PD-1 inhibitor) failed to improve progression-free survival (PFS) or overall survival (OS) compared to standard chemo for recurrent or metastatic NSCLC. In contrast, pembrolizumab (also PD-1 inhibitor) improved both PFS and OS in the similar KEYNOTE-024 trial. The negative nivo trial highlights two important aspects of PD-1 inhibition that should cause pause before drinking the immunotherapy Kool-Aid. First, these drugs don’t work for everyone with NSCLC. Second (as articulated in the editorial), methods of patient selection, specifically the PD-L1 assay, may be more important than previously realized.