Non-small cell lung cancer PDL1 >50%-should we go single or combo?

Recent years have witnessed a revolution in the era of immune checkpoint inhibitors (ICIs). It has greatly impacted the oncological field and especially advanced non-small cell lung cancer (NSCLC) treatment. Here, we summarized the 3 main treatment protocols for a specific population of NSCLC with strong PD-L1 staining (PD-L1 ≥50%); which include ICI (e.g., pembrolizumab) monotherapy, ICI in combination with chemotherapy or combination ICIs. To date, it is uncertain whether there is a therapeutic difference amongst the PD-L1 TPS ≥50% group in comparison to other PD-L1 subdivisions. The findings reviewed here show that the combination ICI with chemotherapy yields the best response rate in comparison to other treatment protocols. Crucially, this treatment protocol is highly suggested for patients with high disease burden, especially for those with liver or brain involvement.