e23229 Background: Multiple PD-1/PD-L1 inhibitors are approved across solid tumors with overlapping indications. Despite class-level similarities, real-world prescribing suggests tumor-specific brand preferences. This study evaluates how efficacy data, clinical familiarity, and access influence brand selection in non-small cell lung cancer (NSCLC), melanoma, and renal cell carcinoma (RCC). Methods: A national mixed-methods study surveyed 102 U.S. hematologist-oncologists from academic (44%, n = 45) and community (56%, n = 57) practices across all U.S. regions (Nov–Dec 2025). A structured online questionnaire assessed brand utilization, sequencing, physician satisfaction, switching behavior, and perceived comparative benefit between pembrolizumab- and nivolumab-based therapies using Likert-type scales and utilization metrics. All participants met predefined screening criteria for patient volume and clinical practice time. Eight qualitative interviews explored drivers of brand choice, sequencing decisions, and switching rationale. Results: PD-1/PD-L1 use was brand-led and tumor-dependent. In 1L NSCLC, 54% identified pembrolizumab-based regimens as better suited than nivolumab, citing longer-term and more mature OS and PFS data, including trials beyond five years, and greater clinical familiarity. Pembrolizumab was favored by academic (61% vs. 2% nivolumab) and community oncologists (48% vs. 2%). In melanoma, brand preference was more balanced, with a modest preference for nivolumab (28% vs. 27%), driven by perceived flexibility in combinations and sequencing, despite higher reported use of pembrolizumab and its selection as preferred 1L monotherapy (55% vs. 35%). This pattern was consistent across practice settings (academic vs. community: pembrolizumab 60% vs. 51.8%; nivolumab 42.5% vs. 30.4%). RCC showed minimal brand differentiation, with 65% reporting pembrolizumab and nivolumab as equally appropriate. Decisions prioritized regimen context, risk stratification, and combination partners, though pembrolizumab was more often perceived as better suited overall (24% vs. 12%), consistent across academic (26% vs. 13%) and community settings (22% vs. 11%). Across tumors, OS and PFS were the most influential drivers (1L NSCLC: OS 93%, PFS 87%; melanoma: OS 91%, PFS 80%; RCC: OS 95%, PFS 92%), followed by toxicity (81%, 83%, 82%) and payer or formulary access (64%, 61%, 62%). About one-third reported switching inhibitors, most often due to insurance requirements or disease progression. Conclusions: PD-1/PD-L1 brand preference is tumor-dependent and shaped by evidence maturity and regimen approvals. These findings suggest preference reflects adherence to trial-informed standards of care rather than perceived drug superiority, while access and formulary pathways continue to play a meaningful secondary role in real-world use.
Parry et al. (Thu,) studied this question.