First-line immunochemotherapy for advanced NSCLC in Asian patients: a meta-analysis of phase 3 RCTs

Background: PD-1/PD-L1 inhibitors plus chemotherapy (PC) are now broadly acknowledged as effective for treating stage IIIb–IV non-small cell lung cancer (NSCLC). However, data specific to Asian populations remain limited, and updated evidence from randomized controlled trials (RCTs) is warranted. In this study, the efficacy and safety of PC are analyzed and compared with those of chemotherapy in this population.

Methods: Six databases were systematically explored to locate applicable phase 3 RCTs. Eligible studies involved Asian patients with stage IIIb–IV NSCLC and compared PC treatment with conventional chemotherapy. Overall survival (OS) and progression-free survival (PFS) were regarded as primary endpoints.

Results: A total of 16 phase 3 RCTs involving 4,452 Asian patients were included. Compared with chemotherapy alone, PC significantly improved OS (HR: 0.68 [0.63, 0.75], p < 0.00001, I² = 30%) and PFS (HR: 0.50 [0.47, 0.54], p < 0.00001, I² = 39%). The survival benefits were consistent across most subgroups and increased as survival time increased. The objective response rate (RR: 1.62 [1.51, 1.74], p < 0.00001, I² = 0%) and disease control rate (RR: 1.09 [1.05, 1.12], p < 0.00001, I² = 7%) were also better in the PC group. Brain metastasis and a PD-L1 CPS >50% were favorable factors in the PC group. However, more immune-related AEs (irAEs) were found in the PC group.

Conclusion: Among Asian patients with stage IIIb–IV NSCLC, PC therapy still has a notable advantage in prolonging survival. Nonetheless, the increased frequency of AEs, particularly irAEs, warrants close attention.

Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251022604, PROSPERO identifier CRD420251022604.

Introduction

Approximately 85% of pulmonary malignancies fall under the category of non-small cell lung cancer (NSCLC), with many detected at stage IIIb–IV, where curative therapies remain limited (1). Over the past decade, the application of immune checkpoint inhibitors (ICIs), which block programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) signaling, has dramatically reshaped therapeutic approaches to advanced NSCLC (2). These agents, especially in combination with chemotherapy, have shown marked survival benefits over chemotherapy alone, setting a new benchmark for first-line therapy (3).

Multiple studies have demonstrated that PD-1/PD-L1 inhibitors + chemotherapy (PC) is beneficial for stage IIIb–IV NSCLC (4–19). As shown in KEYNOTE-189, pembrolizumab with chemotherapy significantly enhanced progression-free survival (PFS) among non-squamous NSCLC cases, irrespective of PD-L1 levels (13). Similarly, in the KEYNOTE-407 trial, survival was improved when pembrolizumab was administered alongside chemotherapy in individuals with squamous NSCLC (14). The IMpower150 study further supported these findings, revealing that atezolizumab + bevacizumab + chemotherapy improved overall survival (OS) in patients with non-squamous NSCLC (20).

Despite the global success of these combination therapies, the majority of pivotal trials have been conducted in predominantly Western populations, leading to a paucity of data specific to Asian patients (21–23). This is particularly concerning given the distinct genetic, environmental, and epidemiological factors that influence NSCLC in Asian populations. For example, compared to Western populations, EGFR mutations occur more commonly in East Asians, which may influence treatment responses and clinical outcomes (24). Moreover, differences in drug metabolism, tolerability, and adverse event profiles necessitate tailored investigations to optimize therapeutic strategies for Asian patients. Recognizing these disparities, recent studies have begun to focus on the effectiveness and tolerability of PC therapy among Asian populations. In the GEMSTONE-302 trial, compared with the chemotherapy-alone group, PFS and OS were notably better in the PC group, which also showed acceptable safety outcomes (10). The efficacy of sintilimab plus chemotherapy was assessed in another study, revealing favorable outcomes irrespective of PD-L1 expression levels (15).

While these studies provide valuable insights, they are limited by sample size and the heterogeneity of study designs. An updated meta-analysis incorporating data from recent phase 3 randomized controlled trials (RCTs) is essential to derive more robust conclusions concerning how PC therapy compares to chemotherapy alone in terms of efficacy and risk among Asian patients diagnosed with stage IIIb–IV NSCLC. By synthesizing data from multiple high-quality RCTs, this study seeks to deliver thorough evidence to support clinical decision-making and improve therapeutic planning in this population.

Materials and methods

Search strategy

Literature up to 15 March 2025 was retrieved from databases such as PubMed, ScienceDirect, Cochrane Library, EMBASE, Scopus, and Web of Science. The search strategy included combinations of the following MeSH terms: “PD-1/PD-L1 inhibitors,” “lung cancer,” and “randomized” (Supplementary Table S1).

Selection criteria

Studies were selected when all of the following conditions were met: 1) were phase 3 RCTs; 2) included individuals diagnosed with stage IIIb–IV NSCLC; 3) either involved Asian participants as a subgroup or focused solely on Asian cohorts. “Asian populations” refers to patients of Asian origin, as defined by the geographical region where the studies were conducted or where subgroup data for Asian patients were explicitly reported; 4) compared the PC group versus chemotherapy alone (chemotherapy group); and 5) included data on at least one measured outcome, such as OS, PFS, response rates, or AEs.

The exclusion criteria were as follows: 1) phase 1/2 design, 2) absence of key efficacy or toxicity endpoints, 3) pooled analyses without specific data for Asian subgroups, or 4) duplicate entries or abstracts lacking complete datasets.

Data extraction

Data from all included studies were independently collected by two reviewers using a uniform extraction template. Collected variables included baseline demographics (sex, stage, etc.), survival outcomes, response rates, and AEs. Any conflicts were settled through consensus.

Outcome assessment

OS and PFS subgroup analyses were conducted on the basis of variables including age, sex, race, ECOG PS, smoking status, pathological type, stage, brain metastases, PD-L1 combined positive score (CPS), PD-1/PD-L1 inhibitor type, and platinum chemotherapy type.

Quality assessment

Two independent reviewers evaluated trial quality and potential bias with the Cochrane tool and Jadad scale. Jadad scoring is based on a 7-point system, where a score between 4 and 7 denotes high study quality (25, 26). Furthermore, evidence strength was graded via the GRADE approach as high, moderate, low, or very low (27).

Statistical analysis

Statistical analyses were conducted using RevMan version 5.4 and STATA 17.0 software. Hazard ratios (HRs) and risk ratios (RRs) were applied to synthesize time-to-event outcomes and binary data from included studies. Between-study heterogeneity was assessed via Cochrane’s Q and I² statistics; I² over 50% or p <0.10 indicated notable heterogeneity. When heterogeneity was substantial, a random-effects model was used; a fixed-effects model was selected under low heterogeneity conditions. Publication bias was examined using funnel diagrams, along with Egger’s and Begg’s statistical tests (28–30). To assess robustness, sensitivity analysis excluded studies one at a time. A two-sided p <0.05 was considered statistically significant.

Results

Search results

Ultimately, this meta-analysis incorporated 39 publications derived from 16 phase 3 RCTs, encompassing 4,452 Asian individuals diagnosed with stage IIIb–IV NSCLC (4–19, 31–53). Figure 1 displays the study selection procedure in a flow diagram formatted according to the PRISMA 2020 standards. Nine RCTs were conducted exclusively in Asia (4, 6–8, 10, 15, 16, 18, 19). The other seven RCTs involved global multicenter designs, with analyses performed on Asian subgroup data (5, 9, 11–14, 17). Three RCTs were subjected to subgroup analysis separately on the basis of the countries where the included patients were located (12–14). The baseline characteristics are detailed in Table 1. Overall study quality was rated as high across all included trials (Supplementary Figure S1, Supplementary Table S2). The evidence levels, assessed via the GRADE method, ranged between moderate and high (Supplementary Table S3).

Figure 1

Figure 1. Flowchart.

Table 1

Table 1. Baseline characteristics of the included studies.

Survival

PC therapy showed significantly superior OS (HR: 0.68 [0.63, 0.75], p < 0.00001, I² = 30%) (Figure 2). The overall survival rate (OSR) was significantly greater for the PC group over a period of 6–60 months (3-year OSR: 34.82% vs. 24.79%; 5-year OSR: 29.76% vs. 17.87%) (Figure 3, Supplementary Figure S2).

Figure 2

Figure 2. Forest plot of overall survival associated with PC versus chemotherapy.

Figure 3

Figure 3. Comparisons of OSR associated with PC versus chemotherapy. (A) OSR at 6–60 months; (B) trend of risk ratios in OSR.

The PC group had increased PFS (HR: 0.50 [0.47, 0.54], p < 0.00001, I² = 39%) (Figure 4). Progression-free survival rate (PFSR) displayed a significant advantage for the PC group over a duration of 6–60 months (3-year PFSR: 19.51% vs. 4.83%; 5-year PFSR: 16.10% vs. 2.42%) (Figure 5, Supplementary Figure S3).

Figure 4

Figure 4. Forest plot of progression-free survival associated with PC versus chemotherapy.

Figure 5

Figure 5. Comparisons of PFSR associated with PC versus chemotherapy. (A) PFSR at 6–60 months; (B) trend of risk ratios in PFSR.

Subgroup analysis

Across various baseline characteristics, PC treatment showed uniform survival advantages in OS and PFS, as detailed in the outcome section. Brain metastasis and a PD-L1 CPS >50% predicted improved OS and PFS outcomes among patients receiving PC (Table 2).

Table 2

Table 2. Subgroup analysis of overall survival and progression-free survival.

Responses

When compared to chemotherapy, PC significantly improved the objective response rate (ORR) (RR: 1.62 [1.51, 1.74], p < 0.00001, I² = 0%) and the disease control rate (DCR) (RR: 1.09 [1.05, 1.12], p < 0.00001, I² = 7%) (Supplementary Figure S4, Table 3).

Table 3

Table 3. Tumor responses.

The PC group had a significantly extended duration of response (DOR) (HR: 0.43 [0.36, 0.50], p < 0.00001, I² = 17%) (Figure 6). Additionally, DOR rates (DORR) favored the PC group at 6–48 months (Figure 7, Supplementary Figure S5).

Figure 6

Figure 6. Forest plot of duration of response associated with PC versus chemotherapy.

Figure 7

Figure 7. Comparisons of DORR associated with PC versus chemotherapy. (A) DORR at 6–48 months; (B) trend of risk ratios in DORR.

Safety

Overall, the PC group had greater incidences of total treatment-emergent adverse events (TEAEs)/immune-related adverse events (irAEs), grade 3–5 TEAEs/treatment-related adverse events (TRAEs)/irAEs, serious TEAEs/TRAEs/irAEs, and TEAEs/TRAEs leading to discontinuation (Table 4).

Table 4

Table 4. Summary of adverse events.

In the TEAE analysis, the PC group exhibited higher rates of any-grade ALT and AST increased, along with 18 additional TEAEs (Supplementary Table S4). Moreover, the PC group also presented higher rates of grade 3–5 lymphocyte count, diarrhea, and rash (Supplementary Table S5).

Within the irAE assessment, patients receiving PC had more frequent hypothyroidism cases and seven additional irAEs (Supplementary Table S6). Moreover, the PC group also had higher rates of grade 3–5 pneumonitis, severe skin reactions, and hypothyroidism (Supplementary Table S7). The top 5 grade 3–5 irAEs in the PC group were pneumonitis (1.81%), severe skin reactions (1.69%), hypothyroidism (1.63%), pneumonia (1.45%), and hepatitis (1.21%).

Sensitivity analysis

Robustness of results was confirmed as sensitivity analyses showed stable pooled RRs for PFSR-6m, stable disease (SD), and grade 3–5 TEAEs. The exclusion of individual studies did not meaningfully affect effect size or variability, indicating robustness of the overall findings (Supplementary Figure S6).

Publication bias

Visual inspection of funnel plots for OS, PFS, ORR, and TEAEs revealed general symmetry (Supplementary Figure S7). Furthermore, no significant publication bias was found by Egger’s and Begg’s tests for these outcomes (all p > 0.05) (Supplementary Figure S8).

Discussion

Compared with standard chemotherapy, the introduction of ICIs, especially those that act on the PD-1/PD-L1 axis, has transformed NSCLC therapy by providing notable survival advantages. However, the majority of clinical trials evaluating these therapies have focused predominantly on Western populations, leaving a gap in understanding their efficacy and safety in Asian patients (21–23). Given the distinct genetic, environmental, and epidemiological factors influencing NSCLC in Asian populations, assessing the applicability of these treatments within this demographic is imperative. To bridge this clinical gap, we conducted a meta-analysis comparing PC therapy with chemotherapy alone in Asian individuals with stage IIIb–IV NSCLC. The results indicated that, compared with chemotherapy alone, PC treatment led to notable improvements in OS and PFS. These survival benefits were consistent across various subgroups. Additionally, the PC regimen was associated with a higher ORR and DCR.

Our findings show that the PC regimen leads to a marked decline in both mortality (HR: 0.68) and disease progression (HR: 0.50). Compared with those in global trial populations, the survival benefits of PC therapy appear to be slightly greater in Asian patients. For example, in ASTRUM-004, which included a predominantly non-Asian cohort, the HR for PFS was 0.77, whereas in Asian patients, the PFS HR was 0.42 (5). Ethnic variations in tumor biology may partly explain the enhanced efficacy of PC therapy in Asian patients. Compared with non-Asian populations, Asian NSCLC patients exhibit a higher prevalence of EGFR mutations, distinct immune-related gene expression profiles, and specific gut microbiome compositions that can modulate the tumor immune microenvironment (54). These biological characteristics may contribute to greater immunogenicity and improved synergy between PD-1/PD-L1 inhibitors and chemotherapy. Moreover, pharmacogenomic differences influencing drug metabolism and immune activation could further enhance treatment sensitivity. Notably, long-term survival benefits became more apparent as the follow-up duration increased. This finding is in line with emerging data emphasizing the durability of immunotherapy-driven responses (10, 15). Furthermore, subgroup analyses revealed that the benefit of PC therapy extended to patients traditionally considered at increased risk. Intriguingly, in our subgroup analysis, patients with brain metastases had unexpectedly favorable OS (HR: 0.54) and an even greater improvement in PFS (HR: 0.38). This finding reinforces the growing body of evidence indicating that ICIs, either alone or in combination, possess intracranial activity (54). Additionally, individuals presenting elevated PD-L1 levels (CPS > 50%) had the greatest improvement in OS (HR: 0.54), which supports the biological basis for employing PD-L1 status as a predictive biomarker. However, our study found that patients with PD-L1 CPS under 1% also showed survival benefit (HR 0.80), indicating that PD-L1 status should not be the sole determinant in clinical decision-making. Potential sources of heterogeneity may include variations in PD-L1 testing assays and thresholds across trials, differences in chemotherapy backbones (platinum-doublet regimens such as cisplatin vs. carboplatin), and minor regional variations in trial conduct or patient enrollment criteria among East Asian populations.

Moreover, PC therapy also significantly improved tumor response outcomes (ORR, DCR, CR, and PR) in Asian patients. These findings reflect enhanced tumor shrinkage and control in the PC group. The depth and durability of response are key indicators of therapeutic efficacy. Our analysis also revealed that DOR was significantly prolonged in the PC group (HR: 0.43), with DORR superiority persisting through 6–48 months. These durable responses may be attributed to the sustained immunological pressure exerted by PD-1/PD-L1 blockade, which enhances the antitumor T-cell activity of patients (55). Several individual trials included in our analysis support these observations. In the Chinese CameL study, camrelizumab plus chemotherapy led to a response rate of 60.5%, which was notably higher than that of chemotherapy alone. Similarly, in the RATIONALE-307 study, tislelizumab-based therapy yielded ORRs above 60%, even in PD-L1-low expressers (19). These consistent patterns reinforce the notion that ICIs enhance chemotherapeutic efficacy by improving antigen presentation and tumor microenvironment modulation. Notably, responses were not significantly different across histologic subtypes, supporting the use of PC across squamous and non-squamous subtypes of NSCLC. In patients with squamous NSCLC, the PC combination led to ORR and PFS improvements comparable to those observed in non-squamous patients. Furthermore, real-world studies from Japan and South Korea have shown that Asian patients may have heightened immunogenic responses to ICIs than their Western counterparts do, potentially due to differences in tumor mutational burden (TMB), the gut microbiome, and HLA profiles (56, 57).

The enhanced efficacy of PC therapy is associated with a higher incidence of AEs, particularly irAEs. Furthermore, TEAEs leading to discontinuation were more common in the PC group (RR: 1.66). This safety profile is consistent with prior studies. In the IMpower132 trial, grade ≥3 TRAEs occurred in 47.2% of individuals receiving atezolizumab versus 36.9% receiving chemotherapy (12). Similarly, in the ORIENT-12 trial, the rate of grade ≥3 TRAEs was 61.3% in the PC group (16). Importantly, while the overall incidence of AEs was elevated, treatment-related mortality did not differ significantly between groups, suggesting that these toxicities are manageable with timely intervention. Our meta-analysis revealed a significantly increased risk of grade 3–5 irAEs, particularly pneumonitis (RR: 3.12, 1.81% vs. 0.64%), rash (RR: 2.13, 1.08% vs. 0.78%), hypothyroidism (RR: 4.69, 1.63% vs. 0.46%), and hepatitis (RR: 1.92, 1.21% vs. 0.46%), in the PC group. Pneumonitis is one of the most clinically concerning toxicities because of its potential severity and overlap with infection or radiation pneumonitis (58). Although colitis was not frequently reported across the included trials, its occurrence in real-world settings has been recognized as a critical irAE. Prompt recognition and early intervention, typically involving corticosteroids and temporary or permanent discontinuation of immunotherapy, are essential to mitigate these risks. Furthermore, we emphasize the need for multidisciplinary collaboration, including pulmonology, endocrinology, and gastroenterology support, to manage such irAEs effectively (59). Importantly, treatment-related mortality did not differ significantly between groups, indicating that, while irAEs are more frequent with PC, they are manageable with appropriate surveillance and intervention. Interestingly, some studies suggest a paradoxical relationship between irAEs and improved survival outcomes. Patients who develop irAEs tend to have more durable responses, possibly reflecting stronger immune activation (60). In Asian cohorts, this phenomenon appears even more pronounced. In a retrospective study in China, NSCLC patients who developed irAEs had significantly longer OS and PFS (61). However, the increased incidence of irAEs also underscores the need for multidisciplinary management and early immunotherapy-specific toxicity education in clinical settings. Moreover, it remains unclear whether certain genetic or pharmacogenomic factors predispose Asian patients to higher irAE rates. Future pharmacovigilance studies in real-world Asian populations could provide valuable insights into risk stratification and prevention strategies for irAEs.

Our pooled results have several direct implications for clinical practice and health policy decision-making in Asian settings. First, although PC therapy provides clear survival and response benefits, the high acquisition cost of ICIs and variability in national reimbursement policies across Asian countries may limit equitable access (62). Second, cost-effectiveness is likely to vary by country, tumor histology, PD-L1 expression, and competing domestic pricing/reimbursement frameworks; therefore, region-specific economic evaluations are urgently needed to inform reimbursement and guideline decisions (63). Third, differential access (urban vs. rural centers, tertiary vs. community hospitals) and local drug availability should be considered when translating trial results into practice; implementation strategies (including biomarker-guided selection and optimized treatment sequencing) may help maximize benefit within constrained resources (64). Finally, real-world pharmacovigilance and prospective health-economic studies in diverse Asian populations are recommended to quantify the value, affordability, and scalability of first-line PC regimens and to inform policy and clinical guideline development (65).

Future studies should focus on real-world pharmacovigilance to better characterize irAEs and treatment tolerability among diverse Asian subpopulations. Additionally, region-specific cost-effectiveness analyses are warranted to inform equitable access and reimbursement strategies, as the high cost and variable availability of ICIs remain significant challenges in many Asian healthcare systems. Multi-omics and translational studies investigating ethnic differences in immune gene expression, tumor mutational burden, and host microbiome composition may further clarify the biological mechanisms underlying the differential efficacy observed in Asian patients.

Despite these robust findings, our meta-analysis has certain limitations. First, the inclusion of studies with varying designs, patient populations, and treatment regimens may introduce heterogeneity. Second, the definition of the Asian population is broad. Some trials enrolled only Chinese (East Asian) patients, while others provided Asian subgroup data without specifying regions. Thus, our analysis cannot differentiate between East, South, or West Asian populations, and future region-specific studies are needed to clarify intra-Asian heterogeneity in immunotherapy outcomes. Third, the number of patients with brain metastases in the included studies was limited, which may reduce the statistical robustness and generalizability of the observed survival benefits in this subgroup. Additionally, the retrospective nature of subgroup analyses limits the ability to draw definitive conclusions for specific patient subsets. The potential for publication bias exists, as studies with negative results may be underreported. Furthermore, the assessment of adverse events relied on reported data from the included trials, which may not capture the full spectrum of real-world toxicities. Finally, the meta-analysis did not evaluate the cost-effectiveness of PC, an essential factor for global healthcare decision-making.

Conclusion

PD-1/PD-L1 inhibitors plus chemotherapy enhance survival benefits in Asian patients with stage IIIb–IV NSCLC. The PC regimen improves response rates and offers durable tumor control. However, the increase in AEs in the PC group, particularly irAEs, highlights the importance of close surveillance and proper management. These findings support the integration of ICIs into first-line treatment regimens for advanced NSCLC in Asian populations, with careful consideration of individual patient factors and potential toxicities. However, country-level cost, reimbursement, and access considerations may affect implementation in Asian health systems; region-specific economic and real-world studies are warranted to guide equitable adoption.

Data availability statement

The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding author.

Author contributions

ZM: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. ZZ: Conceptualization, Data curation, Formal analysis, Writing – original draft. MS: Conceptualization, Data curation, Formal analysis, Writing – original draft. JH: Conceptualization, Data curation, Formal analysis, Writing – original draft. JZ: Conceptualization, Data curation, Formal analysis, Writing – original draft. WL: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing.

Funding

The author(s) declare that no financial support was received for the research, and/or publication of this article.

Acknowledgments

The authors thank Professor Wenxiong Zhang, MD (Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University) for his data collection and statistical advice.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declare that no Generative AI was used in the creation of this manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fonc.2025.1709348/full#supplementary-material

Supplementary Figure 1 | Cochrane Risk Assessment.

Supplementary Figure 2 | Forest plots of OSR at 6–60 months associated with PC versus chemotherapy.

Supplementary Figure 3 | Forest plots of PFSR at 6–60 months associated with PC versus chemotherapy.

Supplementary Figure 4 | Forest plots of responses associated with PC versus chemotherapy.

Supplementary Figure 5 | Forest plots of DORR at 6–48 months associated with PC versus chemotherapy.

Supplementary Figure 6 | Sensitivity analysis of PFSR-6m (A), stable disease (B), and grade 3–5 TEAEs (C).

Supplementary Figure 7 | Funnel plots of OS (A), PFS (B), ORR (C), and total TEAEs (D).

Supplementary Figure 8 | Egger’s and Begg’s tests of OS (A), PFS (B), ORR (C), and grade TEAEs (D).

Glossary

AE: adverse event

ALT: alanine aminotransferase

AST: aspartate aminotransferase

CPS: combined positive score

CR: complete response

CI: confidence interval

DCR: disease control rate

DOR: duration of response

DORR: duration of response rate

EGFR: epidermal growth factor receptor

ECOG PS: Eastern Cooperative Oncology Group Performance Status

GRADE: Grading of Recommendations, Assessment, Development, and Evaluation

HLA: human leukocyte antigen

HR: hazard ratio

ICIs: immune checkpoint inhibitors

irAE: immune-related adverse event

M/F: male/female

NSCLC: non-small-cell lung cancer

ORR: objective response rate

OS: overall survival

OSR: overall survival rate

p: probability

PC: PD-1/PD-L1 inhibitors combined with chemotherapy

PD: progressive disease

PD-1: programmed death-1

PD-L1: programmed death-ligand 1

PFS: progression-free survival

PFSR: progression-free survival rate

PR: partial response

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RCT: randomized controlled trial

RR: risk ratio

SD: stable disease

TEAE: treatment-emergent adverse event

TRAEs: treatment-related adverse events

TMB: tumor mutational burden

References

1. Siegel RL, Kratzer TB, Giaquinto AN, Sung H, and Jemal A. Cancer statistics, 2025. CA Cancer J Clin. (2025) 75:10–45. doi: 10.3322/caac.21871

PubMed Abstract | Crossref Full Text | Google Scholar

2. Wang J, Chen Q, Shan Q, Liang T, Forde P, and Zheng L. Clinical development of immuno-oncology therapeutics. Cancer Lett. (2025) 617:217616. doi: 10.1016/j.canlet.2025.217616

PubMed Abstract | Crossref Full Text | Google Scholar

3. Su PL, Furuya N, Asrar A, Rolfo C, Li Z, Carbone DP, et al. Recent advances in therapeutic strategies for non-small cell lung cancer. J Hematol Oncol. (2025) 18:35. doi: 10.1186/s13045-025-01679-1

PubMed Abstract | Crossref Full Text | Google Scholar

4. Zhong H, Sun S, Chen J, Wang Z, Zhao Y, Zhang G, et al. First-line penpulimab combined with paclitaxel and carboplatin for metastatic squamous non-small-cell lung cancer in China (AK105-302): a multicentre, randomised, double-blind, placebo-controlled phase 3 clinical trial. Lancet Respir Med. (2024) 12:355–65. doi: 10.1016/S2213-2600(23)00431-9

PubMed Abstract | Crossref Full Text | Google Scholar

5. Zhou C, Hu Y, Arkania E, Kilickap S, Ying K, Xu F, et al. A global phase 3 study of serplulimab plus chemotherapy as first-line treatment for advanced squamous non-small-cell lung cancer (ASTRUM-004). Cancer Cell. (2024) 42:198–208.e3. doi: 10.1016/j.ccell.2023.12.004

PubMed Abstract | Crossref Full Text | Google Scholar

6. Zhou C, Chen G, Huang Y, Zhou J, Lin L, Feng J, et al. Camrelizumab plus carboplatin and pemetrexed as first-line therapy for advanced non-squamous non-small-cell lung cancer: 5-year outcomes of the CameL randomized phase 3 study. J Immunother Cancer. (2024) 12:e009240. doi: 10.1136/jitc-2024-009240

PubMed Abstract | Crossref Full Text | Google Scholar

7. Ren S, Chen J, Xu X, Jiang T, Cheng Y, Chen G, et al. Camrelizumab plus carboplatin and paclitaxel as first-line treatment for advanced squamous NSCLC (CameL-Sq): A phase 3 trial. J Thorac Oncol. (2022) 17:544–57. doi: 10.1016/j.jtho.2021.11.018

PubMed Abstract | Crossref Full Text | Google Scholar

8. Zhong J, Fei K, Wu L, Li B, Wang Z, Cheng Y, et al. Toripalimab plus chemotherapy for first line treatment of advanced non-small cell lung cancer (CHOICE-01): final OS and biomarker exploration of a randomized, double-blind, phase 3 trial. Signal Transduct Target Ther. (2024) 9:369. doi: 10.1038/s41392-024-02087-6

PubMed Abstract | Crossref Full Text | Google Scholar

9. Makharadze T, Gogishvili M, Melkadze T, Baramidze A, Giorgadze D, Penkov K, et al. Cemiplimab plus chemotherapy versus chemotherapy alone in advanced NSCLC: 2-year follow-up from the phase 3 EMPOWER-lung 3 part 2 trial. J Thorac Oncol. (2023) 18:755–68. doi: 10.1016/j.jtho.2023.03.008

PubMed Abstract | Crossref Full Text | Google Scholar

10. Zhou C, Wang Z, Sun M, Cao L, Ma Z, Wu R, et al. Interim survival analysis of the randomized phase III GEMSTONE-302 trial: sugemalimab or placebo plus chemotherapy as first-line treatment for metastatic NSCLC. Nat Cancer. (2023) 4:860–71. doi: 10.1038/s43018-023-00578-z

PubMed Abstract | Crossref Full Text | Google Scholar

11. Jotte R, Cappuzzo F, Vynnychenko I, Stroyakovskiy D, Rodríguez-Abreu D, Hussein M, et al. Atezolizumab in combination with carboplatin and nab-paclitaxel in advanced squamous NSCLC (IMpower131): results from a randomized phase III trial. J Thorac Oncol. (2020) 15:1351–60. doi: 10.1016/j.jtho.2020.03.028

PubMed Abstract | Crossref Full Text | Google Scholar

12. Nishio M, Barlesi F, West H, Ball S, Bordoni R, Cobo M, et al. Atezolizumab plus chemotherapy for first-line treatment of nonsquamous NSCLC: results from the randomized phase 3 IMpower132 trial. J Thorac Oncol. (2021) 16:653–64. doi: 10.1016/j.jtho.2020.11.025

PubMed Abstract | Crossref Full Text | Google Scholar

13. Garassino MC, Gadgeel S, Speranza G, Felip E, Esteban E, Dómine M, et al. Pembrolizumab plus pemetrexed and platinum in nonsquamous non-small-cell lung cancer: 5-year outcomes from the phase 3 KEYNOTE-189 study. J Clin Oncol. (2023) 41:1992–8. doi: 10.1200/JCO.22.01989

PubMed Abstract | Crossref Full Text | Google Scholar

14. Sugawara S, Tanaka K, Imamura F, Yamamoto N, Nishio M, Okishio K, et al. Pembrolizumab plus chemotherapy in Japanese patients with metastatic squamous non-small-cell lung cancer in KEYNOTE-407. Cancer Sci. (2023) 114:3330–41. doi: 10.1111/cas.15816

PubMed Abstract | Crossref Full Text | Google Scholar

15. Zhang L, Wang Z, Fang J, Yu Q, Han B, Cang S, et al. Final overall survival data of sintilimab plus pemetrexed and platinum as First-Line treatment for locally advanced or metastatic nonsquamous NSCLC in the Phase 3 ORIENT-11 study. Lung Cancer. (2022) 171:56–60. doi: 10.1016/j.lungcan.2022.07.013

PubMed Abstract | Crossref Full Text | Google Scholar

16. Zhou C, Wu L, Fan Y, Wang Z, Liu L, Chen G, et al. Sintilimab plus platinum and gemcitabine as first-line treatment for advanced or metastatic squamous NSCLC: results from a randomized, double-blind, phase 3 trial (ORIENT-12). J Thorac Oncol. (2021) 16:1501–11. doi: 10.1016/j.jtho.2021.04.011

PubMed Abstract | Crossref Full Text | Google Scholar

17. Peters S, Cho BC, Luft AV, Alatorre-Alexander J, Geater SL, Laktionov K, et al. Durvalumab with or without tremelimumab in combination with chemotherapy in first-line metastatic NSCLC: five-year overall survival outcomes from the phase 3 POSEIDON trial. J Thorac Oncol. (2025) 20:76–93. doi: 10.1016/j.jtho.2024.09.1381

PubMed Abstract | Crossref Full Text | Google Scholar

18. Lu S, Wang J, Yu Y, Yu X, Hu Y, Ma Z, et al. Tislelizumab plus chemotherapy as first-line treatment of locally advanced or metastatic nonsquamous non-small-cell lung cancer (final analysis of RATIONALE-304: a randomized phase III trial). ESMO Open. (2024) 9:103728. doi: 10.1016/j.esmoop.2024.103728

PubMed Abstract | Crossref Full Text | Google Scholar

19. Wang J, Lu S, Yu X, Hu Y, Zhao J, Sun M, et al. Tislelizumab plus chemotherapy versus chemotherapy alone as first-line treatment for advanced squamous non-small-cell lung cancer: final analysis of the randomized, phase III RATIONALE-307 trial. ESMO Open. (2024) 9:103727. doi: 10.1016/j.esmoop.2024.103727

PubMed Abstract | Crossref Full Text | Google Scholar

20. Wu SG, Ho CC, Yang JC, Yu SH, Lin YF, Lin SC, et al. Atezolizumab, bevacizumab, pemetrexed and platinum for EGFR-mutant NSCLC patients after EGFR TKI failure: A phase II study with immune cell profile analysis. Clin Transl Med. (2025) 15:e70149. doi: 10.1002/ctm2.70149

PubMed Abstract | Crossref Full Text | Google Scholar

21. Borghaei H, O’Byrne KJ, Paz-Ares L, Ciuleanu TE, Yu X, Pluzanski A, et al. Nivolumab plus chemotherapy in first-line metastatic non-small-cell lung cancer: results of the phase III CheckMate 227 Part 2 trial. ESMO Open. (2023) 8:102065. doi: 10.1016/j.esmoop.2023.102065

PubMed Abstract | Crossref Full Text | Google Scholar

22. Reck M, Ciuleanu TE, Lee JS, Schenker M, Zurawski B, Kim SW, et al. Systemic and intracranial outcomes with first-line nivolumab plus ipilimumab in patients with metastatic NSCLC and baseline brain metastases from checkMate 227 part 1. J Thorac Oncol. (2023) 18:1055–69. doi: 10.1016/j.jtho.2023.04.021

PubMed Abstract | Crossref Full Text | Google Scholar

23. West H, McCleod M, Hussein M, Morabito A, Rittmeyer A, Conter HJ, et al. Atezolizumab in combination with carboplatin plus nab-paclitaxel chemotherapy compared with chemotherapy alone as first-line treatment for metastatic non-squamous non-small-cell lung cancer (IMpower130): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. (2019) 20:924–37. doi: 10.1016/S1470-2045(19)30167-6

PubMed Abstract | Crossref Full Text | Google Scholar

24. Peng S, Ying AF, Tai BC, and Soo RA. A meta-analysis on immune checkpoint inhibitor efficacy for advanced non-small cell lung cancer between East Asians versus non-East Asians. Transl Lung Cancer Res. (2020) 9:1124–37. doi: 10.21037/tlcr-20-246

PubMed Abstract | Crossref Full Text | Google Scholar

25. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. (1996) 17:1–12. doi: 10.1016/0197-2456(95)00134-4

PubMed Abstract | Crossref Full Text | Google Scholar

26. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. (2011) 343:d5928. doi: 10.1136/bmj.d5928

PubMed Abstract | Crossref Full Text | Google Scholar

27. Guyatt GH, Oxman AD, Schünemann HJ, Tugwell P, and Knottnerus A. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol. (2011) 64:380–2. doi: 10.1016/j.jclinepi.2010.09.011

PubMed Abstract | Crossref Full Text | Google Scholar

28. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. (2011) 343:d4002. doi: 10.1136/bmj.d4002

PubMed Abstract | Crossref Full Text | Google Scholar

29. Langhorne P. Bias in meta-analysis detected by a simple, graphical test. Prospectively identified trials could be used for comparison with meta-analyses. BMJ. (1998) 316:471.

PubMed Abstract | Google Scholar

30. Begg CB and Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. (1994) 50:1088–101. doi: 10.2307/2533446

PubMed Abstract | Crossref Full Text | Google Scholar

31. Zhou C, Chen G, Huang Y, Zhou J, Lin L, Feng J, et al. Camrelizumab plus carboplatin and pemetrexed as first-line treatment for advanced nonsquamous NSCLC: extended follow-up of cameL phase 3 trial. J Thorac Oncol. (2023) 18:628–39. doi: 10.1016/j.jtho.2022.12.017

PubMed Abstract | Crossref Full Text | Google Scholar

32. Zhou C, Chen G, Huang Y, Zhou J, Lin L, Feng J, et al. Camrelizumab plus carboplatin and pemetrexed versus chemotherapy alone in chemotherapy-naive patients with advanced non-squamous non-small-cell lung cancer (CameL): a randomised, open-label, multicentre, phase 3 trial. Lancet Respir Med. (2021) 9:305–14. doi: 10.1016/S2213-2600(20)30365-9

PubMed Abstract | Crossref Full Text | Google Scholar

33. Wang Z, Wu L, Li B, Cheng Y, Li X, Wang X, et al. Toripalimab plus chemotherapy for patients with treatment-naive advanced non-small-cell lung cancer: A multicenter randomized phase III trial (CHOICE-01). J Clin Oncol. (2023) 41:651–63. doi: 10.1200/JCO.22.00727

PubMed Abstract | Crossref Full Text | Google Scholar

34. Baramidze A, Makharadze T, Gogishvili M, Melkadze T, Giorgadze D, Penkov K, et al. Cemiplimab plus chemotherapy versus chemotherapy alone in non-small cell lung cancer with PD-L1 ≥ 1%: A subgroup analysis from the EMPOWER-Lung 3 part 2 trial. Lung Cancer. (2024) 193:107821. doi: 10.1016/j.lungcan.2024.107821

PubMed Abstract | Crossref Full Text | Google Scholar

35. Gogishvili M, Melkadze T, Makharadze T, Giorgadze D, Dvorkin M, Penkov K, et al. Cemiplimab plus chemotherapy versus chemotherapy alone in non-small cell lung cancer: a randomized, controlled, double-blind phase 3 trial. Nat Med. (2022) 28:2374–80. doi: 10.1038/s41591-022-01977-y

PubMed Abstract | Crossref Full Text | Google Scholar

36. Zhou C, Wang Z, Sun Y, Cao L, Ma Z, Wu R, et al. Sugemalimab versus placebo, in combination with platinum-based chemotherapy, as first-line treatment of metastatic non-small-cell lung cancer (GEMSTONE-302): interim and final analyses of a double-blind, randomised, phase 3 clinical trial. Lancet Oncol. (2022) 23:220–33. doi: 10.1016/S1470-2045(21)00650-1

PubMed Abstract | Crossref Full Text | Google Scholar

37. Lu S, Fang J, Wang Z, Fan Y, Liu Y, He J, et al. Results from the IMpower132 China cohort: Atezolizumab plus platinum-based chemotherapy in advanced non-small cell lung cancer. Cancer Med. (2023) 12:2666–76. doi: 10.1002/cam4.5144

PubMed Abstract | Crossref Full Text | Google Scholar

38. Nishio M, Saito H, Goto K, Watanabe S, Sueoka-Aragane N, Okuma Y, et al. IMpower132: Atezolizumab plus platinum-based chemotherapy vs chemotherapy for advanced NSCLC in Japanese patients. Cancer Sci. (2021) 112:1534–44. doi: 10.1111/cas.14817

PubMed Abstract | Crossref Full Text | Google Scholar

39. Rodríguez-Abreu D, Powell SF, Hochmair MJ, Gadgeel S, Esteban E, Felip E, et al. Pemetrexed plus platinum with or without pembrolizumab in patients with previously untreated metastatic nonsquamous NSCLC: protocol-specified final analysis from KEYNOTE-189. Ann Oncol. (2021) 32:881–95. doi: 10.1016/j.annonc.2021.04.008

PubMed Abstract | Crossref Full Text | Google Scholar

40. Horinouchi H, Nogami N, Saka H, Nishio M, Tokito T, Takahashi T, et al. Pembrolizumab plus pemetrexed-platinum for metastatic nonsquamous non-small-cell lung cancer: KEYNOTE-189 Japan Study. Cancer Sci. (2021) 112:3255–65. doi: 10.1111/cas.14980

PubMed Abstract | Crossref Full Text | Google Scholar

41. Garassino MC, Gadgeel S, Esteban E, Felip E, Speranza G, Domine M, et al. Patient-reported outcomes following pembrolizumab or placebo plus pemetrexed and platinum in patients with previously untreated, metastatic, non-squamous non-small-cell lung cancer (KEYNOTE-189): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol. (2020) 21:387–97. doi: 10.1016/S1470-2045(19)30801-0

PubMed Abstract | Crossref Full Text | Google Scholar

42. Gadgeel S, Rodríguez-Abreu D, Speranza G, Esteban E, Felip E, Dómine M, et al. Updated analysis from KEYNOTE-189: pembrolizumab or placebo plus pemetrexed and platinum for previously untreated metastatic nonsquamous non-small-cell lung cancer. J Clin Oncol. (2020) 38:1505–17. doi: 10.1200/JCO.19.03136

PubMed Abstract | Crossref Full Text | Google Scholar

43. Gandhi L, Rodríguez-Abreu D, Gadgeel S, Esteban E, Felip E, De Angelis F, et al. Pembrolizumab plus chemotherapy in metastatic non-small-cell lung cancer. N Engl J Med. (2018) 378:2078–92. doi: 10.1056/NEJMoa1801005

PubMed Abstract | Crossref Full Text | Google Scholar

44. Novello S, Kowalski DM, Luft A, Gümüş M, Vicente D, Mazières J, et al. Pembrolizumab plus chemotherapy in squamous non-small-cell lung cancer: 5-year update of the phase III KEYNOTE-407 study. J Clin Oncol. (2023) 41:1999–2006. doi: 10.1200/JCO.22.01990

PubMed Abstract | Crossref Full Text | Google Scholar

45. Cheng Y, Zhang L, Hu J, Wang D, Hu C, Zhou J, et al. Pembrolizumab plus chemotherapy for Chinese patients with metastatic squamous NSCLC in KEYNOTE-407. JTO Clin Res Rep. (2021) 2:100225. doi: 10.1016/j.jtocrr.2021.100225

PubMed Abstract | Crossref Full Text | Google Scholar

46. Paz-Ares L, Vicente D, Tafreshi A, Robinson A, Soto Parra H, Mazières J, et al. A randomized, placebo-controlled trial of pembrolizumab plus chemotherapy in patients with metastatic squamous NSCLC: protocol-specified final analysis of KEYNOTE-407. J Thorac Oncol. (2020) 15:1657–69. doi: 10.1016/j.jtho.2020.06.015

PubMed Abstract | Crossref Full Text | Google Scholar

47. Mazieres J, Kowalski D, Luft A, Vicente D, Tafreshi A, Gümüş M, et al. Health-related quality of life with carboplatin-paclitaxel or nab-paclitaxel with or without pembrolizumab in patients with metastatic squamous non-small-cell lung cancer. J Clin Oncol. (2020) 38:271–80. doi: 10.1200/JCO.19.01348

PubMed Abstract | Crossref Full Text | Google Scholar

48. Paz-Ares L, Luft A, Vicente D, Tafreshi A, Gümüş M, Mazières J, et al. Pembrolizumab plus chemotherapy for squamous non-small-cell lung cancer. N Engl J Med. (2018) 379:2040–51. doi: 10.1056/NEJMoa1810865

PubMed Abstract | Crossref Full Text | Google Scholar

49. Yang Y, Sun J, Wang Z, Fang J, Yu Q, Han B, et al. Updated overall survival data and predictive biomarkers of sintilimab plus pemetrexed and platinum as first-line treatment for locally advanced or metastatic nonsquamous NSCLC in the phase 3 ORIENT-11 study. J Thorac Oncol. (2021) 16:2109–20. doi: 10.1016/j.jtho.2021.07.015

PubMed Abstract | Crossref Full Text | Google Scholar

50. Yang Y, Wang Z, Fang J, Yu Q, Han B, Cang S, et al. Efficacy and Safety of Sintilimab Plus Pemetrexed and Platinum as First-Line Treatment for Locally Advanced or Metastatic Nonsquamous NSCLC: a Randomized, Double-Blind, Phase 3 Study (Oncology pRogram by InnovENT anti-PD-1-11). J Thorac Oncol. (2020) 15:1636–46. doi: 10.1016/j.jtho.2020.07.014

PubMed Abstract | Crossref Full Text | Google Scholar

51. Johnson ML, Cho BC, Luft A, Alatorre-Alexander J, Geater SL, Laktionov K, et al. Durvalumab with or without tremelimumab in combination with chemotherapy as first-line therapy for metastatic non-small-cell lung cancer: the phase III POSEIDON study. J Clin Oncol. (2023) 41:1213–27. doi: 10.1200/JCO.22.00975

PubMed Abstract | Crossref Full Text | Google Scholar

52. Lu S, Wang J, Yu Y, Yu X, Hu Y, Ai X, et al. Tislelizumab plus chemotherapy as first-line treatment for locally advanced or metastatic nonsquamous NSCLC (RATIONALE 304): A randomized phase 3 trial. J Thorac Oncol. (2021) 16:1512–22. doi: 10.1016/j.jtho.2021.05.005

PubMed Abstract | Crossref Full Text | Google Scholar

53. Wang J, Lu S, Yu X, Hu Y, Sun Y, Wang Z, et al. Tislelizumab plus chemotherapy vs chemotherapy alone as first-line treatment for advanced squamous non-small-cell lung cancer: A phase 3 randomized clinical trial. JAMA Oncol. (2021) 7:709–17. doi: 10.1001/jamaoncol.2021.0366

PubMed Abstract | Crossref Full Text | Google Scholar

54. Eguren-Santamaria I, Sanmamed MF, Goldberg SB, Kluger HM, Idoate MA, Lu BY, et al. PD-1/PD-L1 blockers in NSCLC brain metastases: challenging paradigms and clinical practice. Clin Cancer Res. (2020) 26:4186–97. doi: 10.1158/1078-0432.CCR-20-0798

PubMed Abstract | Crossref Full Text | Google Scholar

55. Paolini L, Tran T, Corgnac S, Villemin JP, Wislez M, Arrondeau J, et al. Differential predictive value of resident memory CD8⁺T cell subpopulations in patients with non-small-cell lung cancer treated by immunotherapy. J Immunother Cancer. (2024) 12:e009440. doi: 10.1136/jitc-2024-009440

PubMed Abstract | Crossref Full Text | Google Scholar

56. Okada M, Ohgino K, Horiuchi K, Sayama K, Arai D, Watase M, et al. Real-world efficacy and safety of atezolizumab for advanced non-small cell lung cancer in Japan: A retrospective multicenter analysis. J Clin Med. (2024) 13:7815. doi: 10.3390/jcm13247815

PubMed Abstract | Crossref Full Text | Google Scholar

57. Jung HA, Sun JM, Lee SH, Ahn JS, Ahn MJ, and Park K. Ten-year patient journey of stage III non-small cell lung cancer patients: A single-center, observational, retrospective study in Korea (Realtime autOmatically updated data warehOuse in healTh care; UNIVERSE-ROOT study). Lung Cancer. (2020) 146:112–9. doi: 10.1016/j.lungcan.2020.05.033

PubMed Abstract | Crossref Full Text | Google Scholar

58. Ma K, Lu Y, Jiang S, Tang J, Li X, and Zhang Y. The relative risk and incidence of immune checkpoint inhibitors related pneumonitis in patients with advanced cancer: A meta-analysis. Front Pharmacol. (2018) 9:1430. doi: 10.3389/fphar.2018.01430

PubMed Abstract | Crossref Full Text | Google Scholar

59. Hirata A, Saraya T, Kobayashi F, Noda A, Aso K, Sakuma S, et al. Immune-related adverse events with immune checkpoint inhibitors: Special reference to the effects on the lungs. Med (Baltimore). (2021) 100:e25275. doi: 10.1097/MD.0000000000025275

PubMed Abstract | Crossref Full Text | Google Scholar

60. Hunting JC, Price SN, Faucheux AT, Olson E, Elko CA, Quattlebaum A, et al. Survival impact of immune-related adverse events in extensive stage small cell lung cancer patients: a retrospective cohort study. Immunotherapy. (2025) 17:19–24. doi: 10.1080/1750743X.2025.2456448

PubMed Abstract | Crossref Full Text | Google Scholar

61. Society of Cancer Precision Medicine of Chinese Anti-Cancer Association and The Lung Cancer Expert Group of Chinese Medical Association Publishing House. Chinese expert consensus on immunotherapy for advanced non-small cell lung cancer with oncogenic driver mutations (2023 edition). Chin Med J (Engl). (2024) 137:1016–8. doi: 10.1097/CM9.0000000000003055

PubMed Abstract | Crossref Full Text | Google Scholar

62. Wu SG, Liao WY, Su KY, Yu SL, Huang YL, Yu CJ, et al. Prognostic characteristics and immunotherapy response of patients with nonsquamous NSCLC with Kras mutation in East Asian populations: A single-center cohort study in Taiwan. JTO Clin Res Rep. (2020) 2:100140. doi: 10.1016/j.jtocrr.2020.100140

PubMed Abstract | Crossref Full Text | Google Scholar

63. Bullement A, Edmondson-Jones M, and Latimer N. Cost-effectiveness of first-line immunotherapy combinations with or without chemotherapy for advanced non-small cell lung cancer: a modelling approach. BMC Cancer. (2024) 24:879. doi: 10.1186/s12885-024-12287-6

PubMed Abstract | Crossref Full Text | Google Scholar

64. Jin R, Liu C, Zheng S, Wang X, Feng X, Li H, et al. Molecular heterogeneity of anti-PD-1/PD-L1 immunotherapy efficacy is correlated with tumor immune microenvironment in East Asian patients with non-small cell lung cancer. Cancer Biol Med. (2020) 17:768–81. doi: 10.20892/j.issn.2095-3941.2020.0121

PubMed Abstract | Crossref Full Text | Google Scholar

65. Luan T, Hao J, Xie X, Lin X, Wang S, Yu B, et al. Real-world single-center data analysis of dual immunotherapy in advanced NSCLC: Efficacy, survival, and adverse events. Hum Vaccin Immunother. (2025) 21:2542068. doi: 10.1080/21645515.2025.2542068

PubMed Abstract | Crossref Full Text | Google Scholar