Imfinzi’s Pacific study in stage III lung cancer raised doubts about giving the drug to all comers, given that it showed a numerically negative effect in a post hoc analysis of PD-L1-negative patients. But today Astrazeneca stressed that doctors in the US, who now have the greatest amount of experience, were largely prescribing Imfinzi in line with its all-comers label. PD-L1 expression is of interest, the group told this morning’s third-quarter media call, but is not being used to inform a decision on whether to use the drug. This year the EU regulator limited Imfinzi’s use in this setting to patients with PD-L1 expression of 1% or above, but no other agency has adopted this stance (World Lung 2018 – Pacific poses PD-L1 testing conundrum, September 27, 2018). Still, for some investors the NSCLC focus remains on metastatic disease, where the dominance of Merck’s Keytruda was one of the reasons behind today’s discontinuation of the mTOR inhibitor vistusertib, Astra suggested; one of its studies included KRAS-positive NSCLC. Imfinzi’s own first-line metastatic NSCLC trial Mystic, which failed on PFS, will yield topline OS data by the end of 2018.