{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T01:56:19Z","timestamp":1781920579408,"version":"3.54.5"},"reference-count":43,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background: This study aimed to evaluate the effectiveness and safety of first-line pembrolizumab monotherapy in patients with advanced non-small cell lung cancer (NSCLC) in real-world clinical practice in Vietnam. Methods: We performed a multicenter retrospective cohort study of patients with locally advanced or metastatic NSCLC who received first-line pembrolizumab monotherapy in Vietnam between January 2018 and August 2024. The primary endpoints were progression-free survival (PFS), overall survival (OS), and safety profile. Results: A total of 73 patients were included, with a median age of 69 years (range, 47\u201392). Most patients had good performance status (ECOG PS 0\u20131, 75.3%) and high PD-L1 expression (TPS \u2265 50%, 86.3%). The overall response rate was 60.3%, and the disease control rate was 79.5%. Median PFS was 11.3 months (95% CI, 6.9\u201315.8), and median OS was 25.4 months (95% CI, 20.8\u201330.0). Multivariate analysis identified never-smoking status (HR 3.14, 95% CI 1.16\u20138.50; p = 0.024), squamous histology (HR 4.09, 95% CI 1.18\u201314.17; p = 0.026), and low PD-L1 expression (TPS 1\u201349%) (HR 3.67, 95% CI 1.14\u201311.78; p = 0.029) as independent predictors of inferior overall survival. Immune-related adverse events, including pneumonitis, hepatitis, nephritis, fever, skin reactions, and myositis, were mostly mild and manageable, with grade 3 toxicity occurring in only 4.2% of patients. Better survival was observed in patients with high PD-L1 expression and non-squamous histology. However, the association with non-squamous histology should be interpreted with caution due to the very small number of squamous cases. Conclusions: First-line pembrolizumab monotherapy demonstrated favorable effectiveness and acceptable safety in patients with advanced NSCLC in real-world clinical practice in Vietnam. Clinical outcomes were particularly favorable in patients with high PD-L1 expression, non-squamous histology, and a history of smoking. Nevertheless, the survival benefit associated with non-squamous histology should be interpreted cautiously, given the limited number of patients with squamous histology. These findings support the use of pembrolizumab monotherapy in selected patient populations within resource-limited settings.<\/jats:p>","DOI":"10.3390\/curroncol33040215","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T10:29:08Z","timestamp":1776162548000},"page":"215","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["First-Line Pembrolizumab Monotherapy for Advanced Non-Small Cell Lung Cancer: A Multicenter Real-World Study from Vietnam"],"prefix":"10.3390","volume":"33","author":[{"given":"Thi Huong","family":"Pham","sequence":"first","affiliation":[{"name":"Department of Oncology, Hanoi Medical University, Hanoi 100000, Vietnam"},{"name":"Nghe An Oncology Hospital, Nghe An 43000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4342-0959","authenticated-orcid":false,"given":"Cam Phuong","family":"Pham","sequence":"additional","affiliation":[{"name":"Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi 100000, Vietnam"},{"name":"Nuclear Medicine Department, Hanoi Medical University, Hanoi 100000, Vietnam"},{"name":"Oncology and Nuclear Medicine Department, University of Medicine and Pharmacy, Vietnam National University, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thi Thu Huong","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Oncology, Hanoi Medical University, Hanoi 100000, Vietnam"},{"name":"Vietnam National Cancer Hospital, Hanoi 100000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5862-3874","authenticated-orcid":false,"given":"Khanh Toan","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Nghe An Oncology Hospital, Nghe An 43000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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