WCLC 2025 - Posters & ePosters-EP.11.11 Real World Outcomes of First-Line Pembrolizumab With or Without Chemotherapy in Patients With Non-Small Cell Lung Cancer

EP.11.11 Real World Outcomes of First-Line Pembrolizumab With or Without Chemotherapy in Patients With Non-Small Cell Lung Cancer

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This retrospective study analyzed real-world survival outcomes of 205 advanced non-small cell lung cancer (NSCLC) patients treated with first-line pembrolizumab either as monotherapy (mono-pembro, n=73) or combined with chemotherapy (chemo-pembro, n=132) at an Australian tertiary center between 2015 and 2024. The goal was to identify factors influencing overall survival (OS) and progression-free survival (PFS) to guide treatment strategies.<br /><br />Key findings indicated a 2-year OS of 42.9% in the mono-pembro cohort, outperforming the 32.5% in the chemo-pembro group. Occurrence of immunotherapy-related adverse events (irAEs) correlated strongly with improved OS and PFS in both cohorts, suggesting irAEs may reflect a more robust systemic immune response to pembrolizumab. Prognostic clinical and biochemical markers favorable for survival included lower Eastern Cooperative Oncology Group (ECOG) performance status, higher albumin levels, and lower lactate dehydrogenase (LDH) and neutrophil-lymphocyte ratios (NLR).<br /><br />Genomic analysis revealed that in the chemo-pembro group, patients with KRAS G12C mutations had significantly better PFS, whereas KRAS non-G12C mutations predicted poorer outcomes with monotherapy. This highlights the potential impact of KRAS mutation subtypes on immunotherapy effectiveness. Smoking history and histology also influenced survival; notably, heavy smoking was linked to increased PFS in the monotherapy group, while adenocarcinoma histology was associated with worse OS.<br /><br />Limitations include incomplete genomic data, available in only 60% of cases, underscoring the need for comprehensive molecular profiling to refine personalized treatment.<br /><br />In conclusion, this real-world study confirms pembrolizumab’s survival benefit in advanced NSCLC and identifies irAEs and certain biomarkers (ECOG, LDH, albumin, NLR, KRAS mutation status) as important predictors of response. These findings support the integration of clinical and molecular factors to optimize immunotherapy strategies in routine care.

Asset Subtitle

Surein Arulananda

Meta Tag

Speaker Surein Arulananda

Topic Metastatic Non-small Cell Lung Cancer – Immunotherapy

Keywords

non-small cell lung cancer

pembrolizumab

immunotherapy

overall survival

progression-free survival

immune-related adverse events

KRAS mutation

biomarkers

ECOG performance status

real-world study