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Non-small cell lung cancer · line 1 · Nivolumab + Ipilimumab + 2-Cycle Platinum-Doublet Chemotherapy (CheckMate-9LA)

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CheckMate-9LA (Paz-Ares 2021, Lancet Oncol; NCT03215706): Phase III RCT, 719 patients, driver-negative stage IV NSCLC, any PD-L1 TPS. Nivo 360 mg q3w + Ipi 1 mg/kg q6w + 2 cycles platinum-doublet chemo vs 4 cycles platinum-doublet chemo alone. Key clinical differentiation: - vs CheckMate-227 (nivo+ipi alone, any PD-L1): addition of 2 chemo cycles provides faster early disease control and higher early ORR; especially advantageous for symptomatic disease, large burden, or when rapid response is needed. - vs KEYNOTE-189/nivo+chemo: dual-IO backbone (nivo+ipi) with chemotherapy provides durable long-tail OS benefit (3-year OS 25% vs 14%) not seen with PD-1 mono + chemo. - PD-L1 subgroup analysis: OS benefit consistent across TPS <1% (HR 0.62), TPS 1–49% (HR 0.79), TPS ≥50% (HR 0.66) — regimen is PD-L1 agnostic. Patient selection: driver-negative stage IV NSCLC is confirmed only after negative comprehensive molecular profiling (NGS panel). PD-L1 testing required to document eligibility but does not stratify treatment in this indication. Chemotherapy component: only 2 cycles administered. Histology-specific selection: squamous → carboplatin AUC 6 + paclitaxel; non-squamous → carboplatin...

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Algoritmos

• ALGO-NSCLC-METASTATIC-1L - ALGO-NSCLC-METASTATIC-1L