{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T10:35:37Z","timestamp":1769164537501,"version":"3.49.0"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,4,15]],"date-time":"2024-04-15T00:00:00Z","timestamp":1713139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Lung cancer is the leading cause of cancer death in Australia. Immunotherapy has improved outcomes in patients with metastatic non\u2010small cell lung cancer (NSCLC). Pembrolizumab is approved in first\u2010line treatment as single\u2010agent immunotherapy (SAI) or combination chemoimmunotherapy (CIT). In metastatic NSCLC programmed death\u2010ligand 1 (PD\u2010L1) \u226550% either regimen may be used.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>We aim to identify patient and tumour characteristics that influence treatment selection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective observational study. Pharmacy records identified patients with metastatic\/recurrent NSCLC receiving pembrolizumab at two metropolitan centres in Victoria, Australia, since 2018. Demographics, tumour characteristics, Charlson Comorbidity Index (CCI) and treatment data were collected. Descriptive and multivariate analyses were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty\u2010one patients had metastatic NSCLC PD\u2010L1 \u226550% and received pembrolizumab with median age of 65.6\u2009years, Eastern Cooperative Oncology Group 0\u20131 in 82%. CIT was administered to 23% (14) with no difference in rate of delivery between centres (<jats:italic>P<\/jats:italic> =\u20090.808). CCI mean score differed (3.38 SAI vs 2.36 CIT, <jats:italic>P<\/jats:italic> =\u20090.042). Patients with high CCI score (\u22652) were less likely to receive CIT (OR\u2009=\u20090.15, <jats:italic>P<\/jats:italic> =\u20090.003, 95% confidence interval (CI) 0.04\u20130.57). Primary tumours over 5 cm were more likely to receive CIT (OR\u2009=\u20093.74, <jats:italic>P<\/jats:italic> =\u20090.043, 95% CI\u2009=\u20091.04\u201313.42). Site\u2010specific metastases of liver, brain and pericardial effusion were not associated with CIT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with higher comorbidity score were less likely to receive CIT, suggesting chemotherapy avoidance in comorbid patients. Larger tumours are associated with CIT use, indicating that oncologists may use tumour size as a surrogate of disease burden. Limitations include small sample size and data cut\u2010off. Future prospective studies could incorporate comorbid status and a validated disease burden score to stratify patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.16389","type":"journal-article","created":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T04:54:18Z","timestamp":1713243258000},"page":"1337-1343","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Treatment selection and real\u2010world analysis of immunotherapy with or without chemotherapy in <scp>PD\u2010L1<\/scp>\u2010high metastatic non\u2010small cell lung cancer"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8081-8501","authenticated-orcid":false,"given":"Samuel","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Medical Oncology St Vincent's Hospital  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Kao","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Chris O'Brien Lifehouse  Sydney New South Wales Australia"},{"name":"Faculty of Medicine and Health School of Medicine, University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Boyer","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Chris O'Brien Lifehouse  Sydney New South Wales Australia"},{"name":"Faculty of Medicine and Health School of Medicine, University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Franco","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Monash Health  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology St Vincent's Hospital  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,4,15]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Cancer Data in Australia.Summary \u2013 Australian Institute of Health and Welfare [Internet]. [Cited 2020 Aug 10]. Available from URL:https:\/\/www.aihw.gov.au\/reports\/cancer\/cancer-data-in-australia\/contents\/summary."},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21442"},{"key":"e_1_2_7_4_1","unstructured":"National Cancer Stage at Diagnosis Data. National Cancer Control Indicators [Internet]. [Cited 2020 Aug 10]. 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