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Poster Display session

52P - Real-world versus clinical trial outcomes of pembrolizumab plus chemotherapy in patients with stage IV non-squamous non-small cell lung cancer


31 Mar 2023


Poster Display session


Marjon Verschueren


Journal of Thoracic Oncology (2023) 18 (4S): S35-S88.


M. Verschueren1, V. Kruik2, B. Peters2, L. Bloem3, A.R. Bijsmans4, T. Egberts3, E. van de Garde3

Author affiliations

  • 1 Nieuwegein/NL
  • 2 St. Antonius Hospital, Nieuwegein/NL
  • 3 Utrecht University - Faculty of Pharmaceutical Sciences, Utrecht/NL
  • 4 Maasstad Hospital, Rotterdam/NL


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Abstract 52P


For many systemic treatments in oncology, a divergence between efficacy in clinical trials versus effectiveness in clinical practice has been observed. The present study investigated the real-world outcomes for pembrolizumab plus chemotherapy in patients with stage IV non-squamous non-small cell lung cancer (NSCLC) and compared these with the results of the KEYNOTE-189 trial.


This retrospective cohort study included all patients diagnosed with stage IV non-squamous NSCLC and treated with first-line pembrolizumab plus pemetrexed-platinum in 2019 and 2020 within a network of seven teaching hospitals (Santeon) in the Netherlands. The overall survival observed in the real-world was compared with the KEYNOTE-189 trial by calculating hazard ratios (HR) with 95% confidence intervals (95%CI) for the total population and PD-L1 subgroups.


A total of 512 patients were included (median age 65 years, 49% males; 9% ECOG-PS 2, and 19% with brain metastasis). The median OS (mOS) was shorter in clinical practice than in the trial (13 vs 22 months) with a HR (95%CI) of 1.50 (1.26–1.79) (table). The divergence from the trial was most pronounced in patients with <1% PD-L1 expression (mOS 10 vs 17 months; HR 1.38, 95%CI 1.06–1.79). Early discontinuation of chemotherapy (<4 cycles platinum) was more frequent in the real-world than the trial (35 vs 18%).

Table: 52P

The overall survival for stage IV non-squamous patients treated with pembrolizumab plus chemotherapy (real-world vs KEYNOTE-189)

Real-world vs KEYNOTE-189
mOS in months (n)HR (95%CI) for OS
Total population13 (512) vs 22 (410)1.50 (1.26–1.79)
PD-L1 subgroups
PD-L1 <1%10 (269) vs 17 (127)1.38 (1.06–1.78)
PD-L1 ≥1–49%20 (158) vs 22 (128)1.10 (0.80–1.51)
PD-L1 ≥50%26 (59) vs 28 (132)1.21 (0.76–1.89)
Unknown9 (26) vs NA (23)NA
mOS, median overall survival; HR, Hazard Ratio; 95%CI, 95% confidence interval; NA, not available.


This study showed considerably worse real-world mOS for pembrolizumab plus chemotherapy compared to the corresponding clinical trial. In patients with low PD-L1 expression, the benefit of pembrolizumab added to chemotherapy seems limited.

Legal entity responsible for the study

The authors.


Has not received any funding.


All authors have declared no conflicts of interest.

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