Herbst RS, Giaccone G, de Marinis F, et al. - For first-line treatment in patients with metastatic non–small-cell lung cancer (NSCLC) with PD-L1 expression, researchers investigated the efficacy and safety of the anti–programmed death ligand 1 (PD-L1) monoclonal antibody atezolizumab vs platinum-based chemotherapy. They performed a randomized, open-label, phase 3 trial enrolling 572 patients with metastatic nonsquamous or squamous NSCLC who had not previously received chemotherapy and who had PD-L1 expression on at least 1% of tumor cells or at least 1% of tumor-infiltrating immune cells as assessed by the SP142 immunohistochemical assay. Participants were randomly assigned to receive atezolizumab or chemotherapy in a 1:1 ratio. Outcomes revealed that, regardless of histologic type, significantly longer overall survival among patients with NSCLC with high PD-L1 expression in correlation with receiving atezolizumab treatment vs platinum-based chemotherapy. The median overall survival was longer by 7.1 months in the atezolizumab group vs the chemotherapy group in the subgroup of patients with EGFR and ALK wild-type tumors who had the highest expression of PD-L1 (205 patients). Grade 3 or 4 adverse events occurred in 30.1% of the patients in the atezolizumab group and 52.5% of the patients in the chemotherapy group.