Physician Views: Is Keytruda use in first-line NSCLC having any impact on second-line treatment trends?

As a companion piece to our recent survey looking at initial use of Keytruda in first-line NSCLC patients (Physician Views Poll Results: Merck & Co.'s Keytruda gaining traction in first-line NSCLC say oncologists), our last Physician Views poll of 2016 assesses how approval of Merck & Co.'s PD-1 inhibitor in the front-line setting is impacting use of immunotherapy in second-line patients.

Since approval last year, Bristol-Myers Squibb's competing PD-1 inhibitor Opdivo has dominated the second-line NSCLC market, thanks largely to a broad label which does not require PD-L1 biomarker testing prior to use. However, with more patients now being tested for PD-L1 status when initially  diagnosed with NSCLC (to assess eligibility for first-line treatment with Keytruda) this commercial dynamic is expected to change. Furthermore, Roche's Tecentriq – a PD-L1 inhibitor offering similar, if not slightly superior, efficacy based on available data – was approved in October for the treatment of second-line NSCLC patients irrespective of PD-L1 status (ViewPoints: Roche's Tecentriq could hit the ground running).

To ascertain whether approval of Keytruda in front-line NSCLC patients is having any impact on second-line treatment trends we are asking US-based oncologists the following questions…

Assuming a first-line NSCLC patient receiving Keytruda monotherapy experienced either progression or recurrence of their disease, would you prescribe another PD-1 or PD-L1 inhibitor as a second-line therapy?


Yes – Favour Opdivo

Yes – Favour Tecentriq

Yes – Either Opdivo or Tecentriq

For first-line NSCLC patients who have experienced either progression or recurrence of their disease following treatment with chemotherapy, would you favour a particular PD-(L)1 inhibitor for second-line therapy?


Yes – Keytruda

Yes – Opdivo

Yes – Tecentriq

For which reason primarily did you select that product?

Familiarity with use of product/biomarker assay in first-line patients

Familiarity with product in second-line patients

PD-L1 status of patient (i.e. either PD-L1 negative or PD-L1 >1%)

Perception of clinical profile for that product

Dosing regimen for that product

Perception of product manufacturer 

Other (please state)

Do you stratify second-line NSCLC patients by PD-L1 status to determine treatment with a particular product?


Yes – 1% or above favour Keytruda / PD-L1 negative favour Opdivo

Yes – 1% or above favour Keytruda / PD-L1 negative favour Tecentriq

Yes – 1% or above favour Keytruda / PD-L1 negative use Opdivo or Tecentriq

In 12 months' time, which of the following PD-(L)1 inhibitor products would you expect to be used most frequently in second-line patients?




Results and related analysis will be published for FirstWord Pharma PLUS subscribers to read, with the opportunity for non-FirstWord Pharma PLUS subscribers to purchase these findings. To be notified when poll results and analysis become available, please click here.

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