Ahmet Dirican, Professor of Medical Oncology at Medicana International İzmir Hospital, shared a post on X:
“Metastatic NSCLC. First-line treatment. No actionable driver alterations. PD-L1 TPS: 90%.
Would you choose immunotherapy monotherapy for this patient?
For many of us, the first answer would probably be ‘Yes.’
However, the 2026 ASCO Living Guideline highlights an important point:
High PD-L1 expression alone may not be sufficient to guide treatment selection.
Treatment decisions should also consider:
- Tumor burden.
- Disease aggressiveness.
- Histology.
- Molecular co-alterations (e.g., STK11, KEAP1).
- Comorbidities and patient preferences.
So, which studies are expected to answer this question?
INSIGNA: Expected to clarify which patients with high PD-L1 expression benefit most from immunotherapy alone versus immunotherapy plus chemotherapy.
TRITON: Evaluating whether molecular co-alterations such as KRAS, STK11, and KEAP1 should influence the choice of immunotherapy strategy.
Perhaps the real question is no longer, ‘What is the PD-L1 level?’ but rather, ‘What is the best treatment for this patient?'”
Other articles featuring Ahmet Dirican on OncoDaily.