In brief
- Of 511 patients with advanced NSCLC, PD-L1 expression of at least 50% and no actionable genomic alterations, 340 (67%) received first-line immunotherapy monotherapy and 23% received immunotherapy with chemotherapy.
- Pembrolizumab monotherapy was the most frequently prescribed regimen.
- Physicians most often gave overall survival and response-related benefits as their reasons for choosing a regimen; quality of life was cited less frequently.
- Fatigue, cough and dyspnoea were common at the time of data collection, and nearly half of the patients required support from a caregiver.
- In patients treated for more than 90 days, EQ-5D-5L and EORTC questionnaires indicated substantial disease burden across the first-line treatment groups.
Study at a glance
- Design: Observational, cross-sectional study using the Adelphi Real World Lung Cancer Disease Specific Programme
- Period and regions: December 2023 to May 2024; Asia, Europe and the USA
- Population: Adults with advanced or metastatic NSCLC, PD-L1 ≥50% and no actionable genomic alterations, who received or were receiving first-line therapy
- Cohort: 511 patients reported by 257 physicians; 148 patients completed patient-reported outcome questionnaires
- First-line treatment: Immunotherapy monotherapy 67% (n=340); immunotherapy plus chemotherapy 23%
- Measures: Treatment patterns, physician-reported reasons for treatment selection, symptoms, EQ-5D-5L and EORTC questionnaires
- Analysis: Descriptive, by first-line regimen
- Not reported: In the abstract, the regimen of the remaining 10% of patients, the questionnaire scores, and any survival or response outcomes
Two-thirds started on immunotherapy alone, with pembrolizumab the most frequent regimen
In this survey, 340 of the 511 patients received immunotherapy monotherapy in the first line, against 23% given immunotherapy combined with chemotherapy. Pembrolizumab monotherapy was the most frequently prescribed regimen. Both approaches are first-line options for patients whose tumours carry no actionable alteration and express PD-L1 at 50% or more.
Survival and response cited as reasons more often than quality of life
When physicians were asked why they had selected a first-line regimen, the reasons they gave most commonly were overall survival and response-related benefits. Quality of life was prioritised less frequently.
The authors describe the predominance of monotherapy as driven primarily by survival benefits as physicians perceived them.
Common symptoms, and caregiver support for nearly half
At the time of data collection, physicians and patients both reported frequent symptoms, among them fatigue, cough and dyspnoea. Nearly half of the patients required caregiver support.
Health-related quality of life was measured with the EQ-5D-5L and EORTC instruments. Among patients treated for more than 90 days, the results indicated substantial disease burden across the first-line treatment groups.
“These findings highlight ongoing unmet needs and underscore the importance of incorporating patient-reported outcomes and quality-of-life considerations into 1L treatment decision-making.”Owen et al., Oncology and Therapy (2026)
Physician surveys at one point in time, with 148 patient questionnaires
The design was observational and cross-sectional: physicians completed surveys on patients who had received or were receiving first-line therapy, and the analysis was descriptive. Of the 511 patients, 148 completed the patient-reported outcome questionnaires.
The authors conclude that considerable symptom burden, functional impairment and caregiver dependence were observed in this population.
Sources
- Oncology and Therapy. Real-World First-Line Treatment Characteristics and Physician Drivers in Advanced/Metastatic Non–Small Cell Lung Cancer, PD-L1 ≥ 50%, and without Actionable Genomic Alterations (2026-10-03). doi.org
Featuring Lung Summit faculty
This study was co-authored by Lung Summit faculty Delvys Rodríguez-Abreu.
This article was produced independently by the Lung Summit editorial team, without industry funding or input.
