Topic Thread

Single Agent Pembrolizumab in Met NSCLC adenocarcinoma

  • 1.  Single Agent Pembrolizumab in Met NSCLC adenocarcinoma

    Posted 6 days ago
    Hi Everyone,

       We have a pt with met NSCLC adenocarcinoma who has negative mutations for EGFR, ALK. His PDL1 status came back as not detected. Initial plan was to start the patient on carboplatin/pemetrexed/pembrolizumab based off of KEYNOTE-189, as it is approved irrespective of PDL1 expression.  The patient ended up delaying treatment because he wanted to think about his options. He later came back saying that he did not want to receive chemotherapy but was amenable to receiving immunotherapy. Although KEYNOTE-189 allowed for maintenance pembro after 4 cycles of combination treatment, he is not willing to try this.

       I know ASCO 2018 recently released some results of the KEYNOTE-042 trial using single agent pembro in the front line setting but it was with patients with PDL1 expression of 1% or more.

       I was wondering if anyone has any experience or advice in this setting of whether to approve or deny use of pembrolizumab. Any evidence or case reports would be great. I appreciate the help!

    John Malamakal, PharmD, MS, BCPS, BCOP
    Hematology/Oncology Clinical Pharmacist Specialist
    South Texas Veterans Health Care System

    John Malamakal PharmD, MS, BCPS, BCOP

  • 2.  RE: Single Agent Pembrolizumab in Met NSCLC adenocarcinoma

    Posted 5 days ago
    Hi!  I'm my personal opinion, EGFR and ALK testing is not sufficient for an advanced stage NSCLC patient.  If getting more tissue testing isn't an option, sending a comprehensive liquid biopsy (blood based) would be ideal. For full disclosure, I work for Guardant (a liquid biopsy company), but I work for them because I've seen how getting full molecular testing can make a huge difference.  Targeted agents are now options for BRAF, RET, Met exon 14 skipping and amps, ROS1, and certain EGFR mutations may have been missed depending on the type of tissue testing performed.  I'm happy to help facilitate the test if you're interested.  My email is

    Ali Roberts