International Journal of
Advanced Multidisciplinary Application

Volume 3, Issue 4

• Author(s)Natalia Petrova, Björn Magnusson, Chiara Romano, Emre Yıldız
• AffiliationDepartment of Medical Oncology and Immunotherapy, Karolinska University Hospital, Stockholm, Sweden
• Page No.83-89
• Volume, Issue & YearVolume 3, Issue 4, April 2026
• Published On2026/04/08
• JournalInternational Journal of Advanced Multidisciplinary Application (IJAMA)
• ISSN No.3048-9350
• DOIhttps://doi.org/10.5281/zenodo.19483861

Article Indexing

Abstract

Non-small cell lung cancer (NSCLC) accounts for approximately 85 percent of all lung cancer diagnoses globally and remains the leading cause of cancer-related mortality, with five-year survival rates below 20 percent for patients presenting with metastatic disease at diagnosis. The development of immune checkpoint inhibitors targeting the PD-1/PD-L1 axis has fundamentally transformed first-line treatment paradigms for advanced NSCLC over the past decade, demonstrating superior progression-free and overall survival compared to platinum-based chemotherapy in patients with PD-L1 expression above 50 percent. However, the optimal biomarker strategy for patient selection, the management of immune-related adverse events (irAEs), and the comparative efficacy across PD-L1 expression subgroups remain incompletely characterised in European population cohorts.
This phase III randomised controlled trial enrolled 624 patients with treatment-naive advanced NSCLC (stage IIIB/IV) across eight oncology centres in Sweden, Italy, Turkey, and Germany. Patients were randomised 1:1 to pembrolizumab plus chemotherapy versus chemotherapy alone, stratified by PD-L1 expression, histological subtype, and ECOG performance status. Primary endpoints were progression-free survival (PFS) and overall survival (OS); secondary endpoints included objective response rate (ORR), irAE profile, tumour mutational burden (TMB) correlation, and quality of life. The immunotherapy arm demonstrated a median PFS of 18.4 months versus 8.2 months in the chemotherapy arm (HR=0.52, 95% CI 0.41–0.66, p<0.001), with PD-L1 ≥50% patients showing an ORR of 64.6 percent.

Keywords: NSCLC, immunotherapy, PD-1, PD-L1, pembrolizumab, checkpoint inhibitor, TMB, irAE, progression-free survival, lung cancer

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