Rationale: Pembrolizumab improves survival when added to chemo as first-line treatment of metastatic NSCLC regardless of PD-L1 expression, so do we even need the chemo? Its anagram (KEYNOTE-024) looked at this exact question for those with PD-L1 of at least 50%, and it was a slam dunk. But before we fall too far down the keyhole, let’s remember nivolumab flopped in this setting. Betting line: Well, this one is no fun because Merck just couldn’t hold it in that the trial met its primary endpoint. Patients with as little as 1% PD-L1 expression randomized to pembro alone had better overall survival than those receiving platinum-based chemo. | ASCO plenary 2018


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