6
Treatment
Negative or Unknown PD-L1 Status (TPS 0%–49%), and PS 0–1
➤ For patients with negative (TPS 0%, <1%, or unknown) and/or low
positive (TPS 1%–49%) PD-L1 expression and SCC, in the absence of
contraindications to immune checkpoint inhibitor therapies:
• 4.1. Clinicians should offer pembrolizumab/carboplatin/(paclitaxel or nab-
paclitaxel (Strong Recommendation; I).
• 4.2. For patients who have the above characteristics AND with contraindications
to immunotherapy AND not deemed candidates for platinum-based therapy,
clinicians should offer standard chemotherapy with non-platinum-based two
drug combinations as outlined in the 2015 update (Strong Recommendation; H).
• 4.3. For patients with contraindications to immunotherapy AND not deemed
candidates for platinum-based therapy, clinicians should offer standard
chemotherapy with non-platinum-based two drug combinations as outlined in
the 2015 update (Weak Recommendation; I).
• 4.4. For patients with low positive PD-L1 (TPS 1%–49%) AND who are
ineligible for or decline combination of doublet platinum/pembrolizumab AND
have contraindications to doublet-chemotherapy, clinicians may offer single-
agent pembrolizumab, in the absence of contraindications to immune checkpoint
therapies (Weak Recommendation; L).
• 4.5. In addition to 2020 recommendations 4.1–4.4, for patients with negative
(TPS 0%) and low positive (TPS 1%–49%) PD-L1 expression, SCC, and PS
0–1, clinicians may offer nivolumab and ipilimumab alone or in combination
with two cycles of platinum-based chemotherapy (Weak Recommendation; M).
PS 2
a. In the context of shared decision making, combination chemotherapy,
single-agent therapy, or palliative therapy alone may be used for
patients with stage IV NSCLC, SCC, and PS2:
• Chemotherapy (Weak Recommendation; EB-B-I).
• Palliative care (Strong Recommendation; EB-B-I).
