{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:20:06Z","timestamp":1791908406244,"version":"4.3.4"},"reference-count":54,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T00:00:00Z","timestamp":1736726400000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Thoracic Cancer"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The long\u2010term real\u2010world effect of immunotherapy (IO) is uncertain in metastatic nonsmall cell lung cancer (mNSCLC). This retrospective observational study aimed to describe treatment patterns following the introduction of IO, estimate real\u2010world treatment effects of IO compared to standard of care, and evaluate the impact of introduction of IO on a real\u2010world population, based on a large dataset of over 10\u2009000 patients with several years of follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from routine care of lung cancer patients were extracted from Flatiron Health including those who received either IO or platinum\u2010based doublet chemotherapy (PBDC) in the first line (1L), or either IO or chemotherapy (CT) in the second line (2L). Real\u2010world overall survival (rwOS) and real\u2010world time to next therapy (rwTTNT) were estimated using Cox regression. Flexible parametric models, relaxing proportional hazard assumptions, were used to evaluate long\u2010term IO effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After 1:1 nearest neighbor matching among 16\u2009754 1L and 6548 2L patients, the hazard ratio (HR) was 0.942 (95% CI, 0.902\u20130.984) in 1L and 0.853 (95% CI, 0.795\u20130.915) in 2L. Adjusting for crossover effects, HR was 0.887 in 1L and 0.775 in 2L. Over the 7\u2010year follow\u2010up, the mean rwOS benefit was 3.2\u2009months for 1L and 2.7\u2009months for 2L. IO significantly delayed rwTTNT in both 1L and 2L. The IO effects increased and persisted over time, with uncertainty in the time\u2010varying HR estimate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>IO improves survival in patients with mNSCLC, though the effect size is smaller than in trials and long\u2010term survival estimates are uncertain.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1759-7714.15535","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T06:49:44Z","timestamp":1736837384000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Long\u2010Term Real\u2010World Survival of Immunotherapy Compared to Chemotherapy for Metastatic Nonsmall Cell Lung Cancer: A Propensity Score\u2010Matched Analysis"],"prefix":"10.1111","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1587-3325","authenticated-orcid":false,"given":"Kun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Neurobiology, Care Sciences and Society Karolinska Institutet  Stockholm Sweden"},{"name":"Nordic HTA, AstraZeneca Nordic AB  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Sweeting","sequence":"additional","affiliation":[{"name":"Statistical Innovation, AstraZeneca  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linus","family":"J\u00f6nsson","sequence":"additional","affiliation":[{"name":"Department of Neurobiology, Care Sciences and Society Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Wilking","sequence":"additional","affiliation":[{"name":"Department of Oncology\u2010Pathology Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,13]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"J.Ferlay M.Colombet I.Soerjomataram et\u00a0al. \u201cGlobal Cancer Observatory: Cancer Today \u201d2020 https:\/\/gco.iarc.fr\/today."},{"key":"e_1_2_10_3_1","unstructured":"N.Howlader A. 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