{
  "abstract": "Introduction: Immune checkpoint inhibitors (ICIs) have become the standard first-line treatment for advanced NSCLC. However, prospective real-world evidence comparing ICI-based therapy with chemotherapy remains limited. We evaluated the effectiveness and safety of ICI-based regimens versus chemotherapy in patients with advanced NSCLC. Methods: In this nationwide prospective pragmatic study, patients with advanced or metastatic NSCLC who received first- or second-line ICIs with or without chemotherapy (ICI ± C) or chemotherapy alone were included. The ICI ± C cohort was prospectively enrolled, whereas the chemotherapy cohort was retrospectively assembled as a historical control. The co-primary endpoints were progression-free survival (PFS) and overall survival (OS). Secondary endpoints included the objective response rate, safety, and subgroup analyses. Results: Among 1520 patients, 1234 received first-line therapy (ICI ± C, N = 525; chemotherapy, n = 709) and 286 received second-line therapy (ICI, n = 262; chemotherapy, n = 24). In the first-line setting, ICI ± C significantly improved survival compared with chemotherapy, with a median PFS of 8.1 versus 5.1 months (hazard ratio [HR] = 0.59, 95% CI: 0.52–0.67) and a median OS of 20.1 versus 9.0 months (HR = 0.47, 95% CI: 0.40–0.54). The objective response rate was 41.0% with ICI ± C and 11.4% with chemotherapy. In the second-line setting, PFS was similar (2.1 versus 3.6 mo; HR = 1.05), whereas OS was longer with ICIs (10.9 versus 6.0 mo; HR = 0.60). Multivariable Cox analyses confirmed that ICI ± C remained independently associated with improved survival (adjusted HR = 0.44 for OS and 0.58 for PFS). Treatment-related adverse events were more frequent with ICI ± C but were generally manageable. Conclusion: In this large prospective real-world cohort, ICI-based therapy significantly improved survival outcomes compared with chemotherapy in advanced NSCLC, particularly in the first-line setting, supporting the effectiveness of immunotherapy-based strategies in routine clinical practice.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea",
    "Division of Hematology and Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Institute of Medical Science, Gyeongsang National University College of Medicine, Jinju, Republic of Korea",
    "Department of Internal Medicine, Division of Hemato-Oncology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea",
    "Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea",
    "Division of Hematology & Medical Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea",
    "Division of Medical Oncology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea",
    "Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Republic of Korea",
    "Department of Hemato-oncololgy, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea",
    "Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea",
    "Division of Hematology-Oncology, Department of Medicine, National Cancer Center, Goyang, Republic of Korea",
    "Department of Statistics, Keimyung University, Daegu, Republic of Korea",
    "Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Corresponding author. Address for correspondence: Myung-Ju Ahn, MD, PhD, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 19,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jinyong Kim, MD, PhD"
    },
    {
      "affs": [
        0
      ],
      "name": "Sehhoon Park, MD, PhD"
    },
    {
      "affs": [
        1
      ],
      "name": "Gyeong-Won Lee, MD, PhD"
    },
    {
      "affs": [
        2
      ],
      "name": "Il-Hwan Kim, MD, PhD"
    },
    {
      "affs": [
        3
      ],
      "name": "Dong-Wan Kim, MD, PhD"
    },
    {
      "affs": [
        4
      ],
      "name": "Yun-Gyoo Lee, MD, PhD"
    },
    {
      "affs": [
        5
      ],
      "name": "Jang Ho Cho, MD, PhD"
    },
    {
      "affs": [
        5
      ],
      "name": "Eun-Kyung Cho, MD, PhD"
    },
    {
      "affs": [
        6
      ],
      "name": "Hyun Woo Lee, MD, PhD"
    },
    {
      "affs": [
        7
      ],
      "name": "Ji-Hyun Park, MD, PhD"
    },
    {
      "affs": [
        8
      ],
      "name": "Eun Joo Kang, MD, PhD"
    },
    {
      "affs": [
        9
      ],
      "name": "Youngjoo Lee, MD, PhD"
    },
    {
      "affs": [
        10
      ],
      "name": "Nak-Hoon Son, PhD"
    },
    {
      "affs": [
        10
      ],
      "name": "So Hyeon Gwon, MS"
    },
    {
      "affs": [
        0
      ],
      "name": "Hyun Ae Jung, MD, PhD"
    },
    {
      "affs": [
        0
      ],
      "name": "Jong-Mu Sun, MD, PhD"
    },
    {
      "affs": [
        0
      ],
      "name": "Se-Hoon Lee, MD, PhD"
    },
    {
      "affs": [
        0
      ],
      "name": "Jin Seok Ahn, MD, PhD"
    },
    {
      "affs": [
        11
      ],
      "name": "Myung-Ju Ahn, MD, PhD"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/57y9a3hnn66t0.bib",
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  "doi": "10.1016/j.jtocrr.2026.101064",
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  "language": "en",
  "licence": "CC-BY-NC-ND",
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  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
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  "pdf_url": "https://europepmc.org/articles/PMC13718642?pdf=render",
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  "pmid": "42960209",
  "published": "2026-08-21",
  "publisher": "Elsevier",
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  "title": "Real-World Evidence of First- or Second-Line Immune Checkpoint Inhibitors Versus Chemotherapy in Advanced NSCLC: A Prospective Pragmatic Multicenter Korean Study",
  "title_text": "Real-World Evidence of First- or Second-Line Immune Checkpoint Inhibitors Versus Chemotherapy in Advanced NSCLC: A Prospective Pragmatic Multicenter Korean Study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:22:38Z",
  "url": "https://research.draconitic.com/paper/57y9a3hnn66t0",
  "venue": "JTO Clinical and Research Reports",
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