What is the role of upfront pembrolizumab in metastatic PD-L1 positive NSCLC presenting with SVC syndrome?

This is a "trick question" as there are at least 3 difficult questions hidden here-

1. Can systemic therapy replace the need for local therapy in urgent clinical situations traditionally calling for radiation?
2. What is the best upfront treatment regimen for a patient with PD-L1 positive NSCLC?
3. What is t...