ArticleJTO clinical and research reports2026
Brief Report: Real-World Comparative Effectiveness of First-Line Immune Checkpoint Inhibitor Monotherapy Versus Chemo-Immunotherapy in Metastatic NSCLC With PD-L1 More Than or Equal to 50%: A Meta-Analysis.
Article in JTO clinical and research reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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6 authors.
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Abstract
Introduction: For patients with metastatic NSCLC and high PD-L1 expression (≥50%), both immune checkpoint inhibitor (IO) monotherapy and chemo-immunotherapy (chemo-IO) are established first-line options. Although randomized trials have suggested similar overall survival (OS) between these strategies, real-world outcomes-especially in clinically heterogeneous populations-remain poorly defined. Methods: A systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines was conducted. Eligible studies were retrospective comparative cohorts evaluating first-line IO monotherapy versus chemo-IO in adults with metastatic NSCLC and PD-L1 more than or equal to 50%. Primary outcome was OS; secondary outcomes included progression-free survival and objective response rate. Hazard ratios (HRs) were pooled using random-effects models. Results: A total of 19 retrospective studies comprising 11,048 patients were included (3337 chemo-IO; 7711 IO monotherapy). Chemo-IO significantly improved objective response rate (60% versus 41%). Pooled analyses demonstrated a benefit for chemo-IO in progression-free survival (HR = 0.75, 95% confidence interval [CI]: 0.67-0.85) and OS (HR = 0.82, 95% CI: 0.75-0.90). Subgroup analyses revealed marked heterogeneity: OS benefit of chemo-IO was pronounced in patients with Eastern Cooperative Oncology Group performance status of 0 (HR = 0.45, 95% CI: 0.32-0.63), in never-smokers (HR = 0.35, 95% CI: 0.17-0.70), and in women (HR = 0.68, 95% CI: 0.58-0.80). No significant OS advantage was observed in patients with PS more than or equal to 2 or age more than or equal to 75 years. Conclusions: In real-world practice, chemo-IO provides potential clinical benefit than IO monotherapy in PD-L1-high metastatic NSCLC, although the magnitude varies by patient characteristics. Ongoing prospective trials are essential to refine treatment selection and identify patients for whom chemotherapy can be safely omitted.
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