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.

introductionFor patients with advanced/metastatic non-small cell lung cancer (aNSCLC) without actionable genomic alterations (AGAs) and with programmed death-ligand 1 (PD-L1) ≥ 50%, first-line (1L) treatment options include immunotherapy (IO) monotherapy or IO with chemotherapy. However, real-world data describing treatment patterns, physician decision-making, and patient-reported disease burden remain limited.

methodsThis observational, cross-sectional study used data from the Adelphi Real World Lung Cancer Disease Specific Programme™, conducted between December 2023 and May 2024 in Asia, Europe, and the USA. Physicians completed surveys on adults with aNSCLC, PD-L1 ≥ 50%, and no AGAs, who received or were receiving 1L therapy. Treatment patterns, physician-reported reasons for treatment selection, symptoms, and patient-reported outcomes (PROs) were descriptively analyzed by 1L regimen (IO monotherapy, IO + chemotherapy).

resultsOverall, 257 physicians reported data for 511 patients; 148 patients completed PRO questionnaires. Most patients received 1L IO monotherapy (n = 340, 67%), while 23% received IO + chemotherapy. Pembrolizumab monotherapy was the most frequently prescribed regimen across regions. Physicians most commonly cited overall survival and response-related benefits as reasons for 1L treatment selection; quality of life was less frequently prioritized. Both physician- and patient-reported symptoms were common at data collection, including fatigue, cough, and dyspnea. Nearly half of patients required caregiver support. Health-related quality of life, assessed using EQ-5D-5L and European Organisation for Research and Treatment of Cancer (EORTC) instruments, indicated that among patients treated for more than 90 days, substantial disease burden was present across 1L treatment groups.

conclusionsIn real-world clinical practice, two-thirds of patients with aNSCLC, PD-L1 ≥ 50%, and no AGAs received 1L IO monotherapy, driven primarily by perceived survival benefits on part of physicians. Considerable symptom burden, functional impairment, and caregiver dependence were observed across the 1L treatment groups evaluated. 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.