Eligible pts (age ≥18 years) were identified from the Flatiron Health database (January 2011 - March 2022) with confirmed aNSCLC (Stage III−IV) who received either 1L IO monotherapy or IO+CT....Median OS and rwPFS were lowest in the tumor PD-L1 <1% subgroup among pts treated with IO+CT regardless of histology as well as among SQ pts receiving IO monotherapy….The real-world survival estimates were generally lower than those reported in pivotal trials and it further affirms the unmet need among patients with aNSCLC, especially among those with low PD-L1 expression levels.

...this study focused on the relationship of the exosomal PD-L1 and clinical response of immunotherapy in NSCLC patients to evaluate whether it could be used as a biomarker to predict the efficacy of ICIs...our study found that the expression level of exosomal PD-L1 lower at pre-treatment, or the max fold increasing change higher at 3-6 weeks had higher disease control rate and longer progression free survival. It revealed that exosomal PD-L1 was associated with the treatment response of patients using ICIs and provided a new tool for the evaluation of clinical efficacy of lung cancer immunotherapy.

CONTRADICTORY EVIDENCE: A total of 78 patients with NSCLC treated with immunotherapy as 2nd or 3rd line therapy after platinum-based chemotherapy….lower PD-L1 expression (P = 0.036) and higher GPS (P = 0.007) were independently associated with shorter OS.

In patients with advanced NSCLC with PD-L1＜1%, ICIs improved OS (P=0.001) compared with chemotherapy, but the PFS (P=0.97) and ORR (P=0.34) were no statistical significances…