Does real-world data support using pembrolizumab for my advanced Non-Small Cell Lung Cancer?

If you have advanced non-small cell lung cancer (NSCLC) with high PD-L1 expression (50% or more), pembrolizumab is a standard first-line treatment. Real-world studies, which look at how treatments work in everyday clinical practice outside of clinical trials, strongly support its use. These studies include thousands of patients and show that pembrolizumab can extend survival, with many people living for years. However, your individual results may depend on factors like your overall health, age, and whether you have certain genetic mutations.

What the research says

A large real-world meta-analysis of 12 studies including 17,506 patients found that first-line pembrolizumab monotherapy for advanced NSCLC with PD-L1 ≥50% led to a pooled mean overall survival (OS) of 21.0 months and a 5-year OS rate of 29% ⁸. The mean progression-free survival (PFS) was 8.7 months ⁸. These results are consistent with clinical trial findings and confirm that pembrolizumab works well in real-world populations. Another real-world study of 494 patients from Spain reported a median OS of 15.9 months and median PFS of 9.9 months, with an overall response rate of 43% ¹⁰. Factors like poor performance status (ECOG ≥2) and low body mass index were linked to worse outcomes ¹⁰. A study of patients who completed two years of pembrolizumab found a median PFS of 46.1 months, suggesting that those who tolerate and respond well can have long-lasting benefits ¹¹. Additionally, a study of 1,944 patients receiving pembrolizumab maintenance therapy after initial chemo-immunotherapy showed that higher PD-L1 expression (≥50%) was associated with longer time to next treatment or death ⁹. Importantly, these real-world studies excluded patients with EGFR or ALK mutations, as those patients typically respond better to targeted therapies ⁸¹⁰¹¹.

What to ask your doctor

• What is my PD-L1 expression level, and does it make me a good candidate for pembrolizumab?
• Should I be tested for EGFR, ALK, or other genetic mutations before starting pembrolizumab?
• How might my age, performance status, or other health conditions affect my outcomes with pembrolizumab?
• What are the possible side effects of pembrolizumab, and how are they managed?
• If I respond well, how long would I typically stay on pembrolizumab, and what happens after treatment ends?