Mok TSK, et al. - Researchers studied overall survival of locally advanced or metastatic non-small-cell lung cancer patients with a programmed death ligand 1 (PD-L1) tumor proportion score (TPS) of 1% or more who were treated with first-line pembrolizumab monotherapy in this trial conducted in 213 medical centers in 32 countries. Adults (≥18 years) with previously untreated locally advanced or metastatic non-small-cell lung cancer without a sensitive EGFR mutation or ALK translocation and with an Eastern Cooperative Oncology Group performance score of 0 or 1, the life expectancy of 3 months or longer and a PD-L1 TPS of 1% or more were eligible. Study participants included 1,274 patients (902 men, 372 women, median age 63 years [IQR 57–69]). In total, 637 received pembrolizumab and 637 received chemotherapy. The pembrolizumab group had significantly longer overall survival across all TPS populations vs the chemotherapy group. According to the benefit-to-risk profile, pembrolizumab monotherapy as first-line therapy may be extended to patients with locally advanced or metastatic non-small-cell lung cancer without sensitizing EGFR or ALK alterations and with low PD-L1 TPS.