Authors
Akhil Deepak Vatvani, Gilbert Lazarus, Reyad Al Jabiri, Rama Nada, Maria Albuja Altamirano, Eunhee Choi, Nehad Shabarek
Published in
Immunotherapy. Pages 1-11. Apr 27, 2026. Epub Apr 27, 2026.
Abstract
Pembrolizumab plus chemotherapy is widely used as first-line treatment for advanced NSCLC, but its benefit in patients with low PD-L1 expression remains uncertain. This study evaluated pembrolizumab plus chemotherapy versus chemotherapy alone in advanced or metastatic NSCLC with PD-L1 <50%.
PubMed, Scopus, and Cochrane databases were searched for randomized controlled trials up to 17 September 2025. Primary outcomes were overall survival (OS) and progression-free survival (PFS).
Four randomized controlled trials (n = 2,413) were included. Pembrolizumab plus chemotherapy improved overall survival (HR 0.67, 95% CI 0.46-0.96), while progression-free survival showed a non-significant trend (HR 0.66, 95% CI 0.42-1.03). Subgroup analyses by PD-L1 (<1% and 1-49%) showed borderline, non-significant effects. Objective response rate was higher overall (RR 1.75, 95% CI 1.13-2.70) but not significant by subgroup, with moderate heterogeneity. Certainty of evidence was low. Safety outcomes were not pooled; available data suggested similar adverse events but higher immune-related toxicity and numerically higher treatment-related deaths.
Pembrolizumab plus chemotherapy may improve survival in advanced NSCLC with low PD-L1 expression, but benefits were inconsistent across subgroups and limited by imprecision and heterogeneity. Safety data remain limited and should be interpreted cautiously.
PMID:
42046364
Bibliographic data and abstract were imported from PubMed on 28 Apr 2026.
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