PD-L1 TPS informs pembrolizumab monotherapy selection in metastatic NSCLC; the TPS thresh...
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| ID | BMA-PDL1-TPS-NSCLC |
|---|---|
| Type | Pertinence thérapeutique |
| État | reviewed 2026-05-07 | actionability review required |
| Maladies | DIS-NSCLC |
| Sources | SRC-ESMO-NSCLC-METASTATIC-2024 SRC-KEYNOTE-024-RECK-2016 SRC-KEYNOTE-042-MOK-2019 SRC-KEYNOTE-189-GANDHI-2018 SRC-KEYNOTE-407-PAZ-ARES-2018 SRC-NCCN-NSCLC-2025 |
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| Biomarqueur | BIO-PDL1-TPS |
|---|---|
| Maladie | DIS-NSCLC |
| Niveau ESCAT | IA |
| Combinaisons recommandées | pembrolizumab monotherapy (TPS≥50% 1L per SRC-KEYNOTE-024-RECK-2016, SRC-NCCN-NSCLC-2025), pembrolizumab + carboplatin + pemetrexed (regardless of TPS; non-sq 1L, no sensitizing EGFR/ALK alterations; per SRC-KEYNOTE-189-GANDHI-2018), pembrolizumab + carboplatin + either paclitaxel or nab-paclitaxel (regardless of TPS; sq 1L; per SRC-KEYNOTE-407-PAZ-ARES-2018) |
| Résumé des faits | PD-L1 TPS informs pembrolizumab monotherapy selection in metastatic NSCLC; the TPS threshold for monotherapy must not be applied to chemo-immunotherapy. KEYNOTE-189 studied pembrolizumab + pemetrexed + platinum in non-squamous disease without sensitizing EGFR or ALK alterations. KEYNOTE-407 studied pembrolizumab + carboplatin + either paclitaxel or nab-paclitaxel in squamous disease. These combinations are not restricted to TPS >=1%; the trials included TPS <1% and benefit was observed across PD-L1 categories. The two taxanes are alternatives, not simultaneous components. Histology, driver status, fitness and contraindications still require clinical assessment. This record supplies evidence context, not a treatment-selection rule. |
Notes
Variant_qualifier null — TPS is a continuous score (0-100%); threshold gating enforced by the algorithm/indication layer. TPS ≠ CPS: TPS counts only PD-L1+ tumor cells; CPS additionally counts PD-L1+ immune cells. EGFR/ALK/ROS1/BRAF/KRAS/MET driver alterations take priority over PD-L1 TPS — algorithm checks driver status first.
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