First-Line Nivolumab in Stage IV or Recurrent Non–Small-Cell Lung Cancer

Although pembrolizumab has appeared to be more effective than chemotherapy in patients with lung cancer whose tumors had at least 50% PD-L1–positive cells, nivolumab was not as effective as chemotherapy in patients with lung cancer whose tumors had PD-L1 expression of at least 5%. For the past two decades, platinum-based combination chemotherapy has been the standard-of-care, first-line treatment for patients with advanced non–small-cell lung cancer (NSCLC) without mutations that were sensitive to targeted therapy. 1 , 2 However, chemotherapy has provided only a moderate benefit, with a limited safety profile. In phase 3 clinical trials, the median progression-free survival with platinum-based chemotherapy was 4 to 6 months, and the median overall survival was 10 to 13 months. 3 – 8 In two phase 3 trials, nivolumab, a programmed death 1 (PD-1) immune-checkpoint–inhibitor antibody, resulted in significantly longer overall survival than docetaxel among patients with metastatic NSCLC who had . . .