Reduced CT + Anti-PD-1 as First Line Tx in Vulnerable Older Adults w/Adv <50% PD-L1 Non-Small Cell Lung Cancer (NSCLC)

Inclusion Criteria

• •Histologically or cytologically confirmed diagnosis of non-small cell lung cancer (NSCLC) (either squamous or non- squamous)
• •Stage IIIB, IIIC or IV disease OR have recurrent disease and not be candidates for curative treatment such as combined chemo-radiation
• •No previous line of treatment in the recurrent or metastatic setting. Neoadjuvant or adjuvant treatment more than 6 months before enrollment is acceptable.
• •Age 70 or meeting frailty definition or above at the date of signing informed consent
• •Absence of driver mutations that have first line Food and Drug Administration (FDA) approved targeted therapy (biomarker testing is optional for squamous cell)
• •PD-L1 tumor proportion score (TPS) of less than 50%
• •Eastern Cooperative Oncology Group (ECOG) PS of 0-3
• •Have measurable disease based on RECIST 1.1 as determined by the local site investigator/radiology assessment
• •Absolute neutrophil count (ANC) ≥ 1,000/μL
• •Platelets ≥ 75,000/μL
• •Hemoglobin (Hgb) ≥ 8.0 g/dL (transfusion permitted)
• •Total bilirubin ≤ 2 x institutional upper limit of normal (ULN)
• •Aspartate amino transferase (AST)serum glutamic-oxaloacetic transaminase (SGOT) /alanine aminotransferase (ALT)serum glutamic-pyruvic transaminase (SGPT) ≤ 5.0 × institutional ULN
• •Ability to understand and the willingness to sign a written informed consent document