With different FDA-approved immune checkpoint inhibitor drugs for use in NSCLC ?Atezolizumab, nivolumab, and pembrolizumab – their place in therapy is becoming better ?defined. ?All three have solid second-line plus indications, with atezolizumab and nivolumab being more ?efficacious than chemotherapy irrespective of PD-L1 expression; however, pembrolizumab is ?approved for use in those patients with ?1% staining. Pembrolizumab holds a first-line ?indication for single-agent treatment in those patients with ?50% PD-L1 expression, which ?included 28% of first-line patients in the KEYNOTE trials. The OAK trial demonstrated a survival ?benefit over chemotherapy in both squamous and nonsquamous disease, regardless of the PD-?L1 expression; however, significant responses and survival benefits were seen in patients with ?high PD-L1 expression, confirming this as a reliable predictive biomarker for identifying those ?patients most likely to benefit from atezolizumab. Remarkably, PD-L1 expression was not linked ?to nivolumab efficacy in squamous histology. Nevertheless, regarding the checkpoint inhibitor ?that should be used in the second-line setting is still unsettled. ?Presently, Atezolizumab`s dosing schedule may be more promising every 3 weeks compared to ?every 2 weeks for nivolumab and pembrolizumab.
correspondingly, it does not necessitate a ?minimum PD-L1 percent expression. ?Additional trials outcomes will benefit to outline the best role for these agents, as well as ?possible indications for the other PD-L1 inhibitors avelumab and durvalumab