Klin Onkol 2025; 38(3): 192-200. DOI: 10.48095/ccko2025192.
Background: This study aimed to describe real-world PD-L1 testing and first-line (1L) treatment patterns for advanced non-small cell lung cancer (NSCLC), and clinical outcomes for metastatic NSCLC after 1L pembrolizumab monotherapy became reimbursed in the Czech Republic (February 2019). Patients and methods: This descriptive noninterventional study drew on two Czech lung cancer registries. We examined PD-L1 testing patterns and results in the KELLY registry for samples submitted on/after 1-Feb-2019 from adult patients with advanced NSCLC. Using the TULUNG registry, we summarized 1L targeted therapies initiated on/after 1-Feb-2019 for advanced NSCLC, in addition to characteristics and outcomes for patients treated with 1L pembrolizumab monotherapy for metastatic NSCLC, PD-L1 tumor proportion score (TPS) ≥ 50%, and no known EGFR/ALK alterations. Real-world time on treatment (rwToT) and overall survival (OS) were determined using Kaplan-Meier curves. The data cutoff was 16-Sept-2021. Results: The percentage of NSCLC samples in the KELLY registry tested for PD-L1 expression increased from 70.5% in 2019 to 84.4% in 2021. Pembrolizumab monotherapy was the most common 1L targeted therapy in 2019–2021 for patients with advanced NSCLC and PD-L1 TPS ≥ 50% (N = 315), administered to 70–80% each year. Of 235 patients with metastatic NSCLC who received 1L pembrolizumab monotherapy, median age was 69 years, 54% were men, 52% were current smokers, and 28% had squamous NSCLC. Median rwToT was 8.5 months (95% CI; 6.7–10.1), with 6- and 12-month on-treatment rates of 59% and 36%, respectively, for 199 patients with ≥ 6 months of follow-up. With added national registry mortality data, estimated median OS was 13.7 months (12.3–17.7); 6- and 12-month OS rates were 70% and 59%, respectively. Conclusions: The rates of PD-L1 testing increased from 2019 to 2021. Median OS among patients with metastatic NSCLC and PD-L1 TPS ≥ 50% treated with pembrolizumab was lower than in clinical trials, likely due to differences between real-world patients and trial participants in age, smoking status, performance status, and squamous histology.