Health-Related Quality of Life in Firstline Advanced or Metastatic Non-Small Cell Lung Cancer: A Systematic Review With Focus on the PD-L1 Negative Subgroup
Author(s)
Nadia Karim, MSc1, Vidhi Patel, MSc2, Thomas Macmillan, MSc3, Ihtisham Sultan, PhD4, Björn Stollenwerk, PhD5.
1Amgen Ltd., Uxbridge, United Kingdom, 2Cytel, Toronto, ON, Canada, 3Cytel Inc., London, United Kingdom, 4Amgen Inc., Thousand Oaks, CA, USA, 5Amgen (Europe) GmbH, Rotkreuz, Switzerland.
1Amgen Ltd., Uxbridge, United Kingdom, 2Cytel, Toronto, ON, Canada, 3Cytel Inc., London, United Kingdom, 4Amgen Inc., Thousand Oaks, CA, USA, 5Amgen (Europe) GmbH, Rotkreuz, Switzerland.
OBJECTIVES: Advanced or metastatic non-small cell lung cancer (a/m NSCLC) is associated with substantial symptom burden and impaired quality of life. Immunotherapies have improved outcomes in first-line (1L) treatment, but their impact on health-related quality of life (HRQoL), particularly in PD-L1 negative (<1%) patients, is not yet fully understood. This systematic literature review (SLR) aimed to evaluate HRQoL and utility/disutility outcomes among patients receiving 1L therapies for a/m NSCLC, with a focus on the PD-L1 negative subgroup.
METHODS: A systematic search (2018-2024) was conducted per PRISMA guidelines. Studies were included if they reported HRQoL or utility outcomes in adults with 1L non-resectable a/m NSCLC. Outcomes were summarized by treatment type and biomarker subgroup, including PD-L1 status.
RESULTS: Fifty-four unique studies were included: 31 RCTs, 18 observational studies, and 4 single-arm trials. Common HRQoL instruments included EORTC QLQ-C30 (n=24), QLQ-LC13 (n=13), FACT-L (n=10), and EQ-5D (n=9). Across studies, immunotherapy plus chemotherapy improved or maintained HRQoL compared to chemotherapy alone. HRQoL outcomes varied by PD-L1 expression, histology, presence of brain/liver metastases, and treatment regimen. Ten studies reported HRQoL outcomes by PD-L1 subgroup. EMPOWER-Lung 3 uniquely reported outcomes for PD-L1 <1% patients, showing significant improvements in domains such as cognitive functioning and pain, though benefits were less consistent and broad than in PD-L1 positive subgroups. The most extensive improvements were observed in the PD-L1 1-49% group. These findings highlight meaningful HRQoL gains and underscore response heterogeneity by biomarker status.
CONCLUSIONS: Immunotherapy plus chemotherapy improves or maintains HRQoL in advanced NSCLC across all PD-L1 subgroups, with the most consistent benefits seen in PD-L1 positive patients. In PD-L1 negative disease, meaningful improvements in cognitive functioning and pain were reported, though evidence is limited to one study, adding uncertainty. These findings support biomarker driven treatment decisions and underscore the need for further research on HRQoL in NSCLC.
METHODS: A systematic search (2018-2024) was conducted per PRISMA guidelines. Studies were included if they reported HRQoL or utility outcomes in adults with 1L non-resectable a/m NSCLC. Outcomes were summarized by treatment type and biomarker subgroup, including PD-L1 status.
RESULTS: Fifty-four unique studies were included: 31 RCTs, 18 observational studies, and 4 single-arm trials. Common HRQoL instruments included EORTC QLQ-C30 (n=24), QLQ-LC13 (n=13), FACT-L (n=10), and EQ-5D (n=9). Across studies, immunotherapy plus chemotherapy improved or maintained HRQoL compared to chemotherapy alone. HRQoL outcomes varied by PD-L1 expression, histology, presence of brain/liver metastases, and treatment regimen. Ten studies reported HRQoL outcomes by PD-L1 subgroup. EMPOWER-Lung 3 uniquely reported outcomes for PD-L1 <1% patients, showing significant improvements in domains such as cognitive functioning and pain, though benefits were less consistent and broad than in PD-L1 positive subgroups. The most extensive improvements were observed in the PD-L1 1-49% group. These findings highlight meaningful HRQoL gains and underscore response heterogeneity by biomarker status.
CONCLUSIONS: Immunotherapy plus chemotherapy improves or maintains HRQoL in advanced NSCLC across all PD-L1 subgroups, with the most consistent benefits seen in PD-L1 positive patients. In PD-L1 negative disease, meaningful improvements in cognitive functioning and pain were reported, though evidence is limited to one study, adding uncertainty. These findings support biomarker driven treatment decisions and underscore the need for further research on HRQoL in NSCLC.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
PCR116
Topic
Patient-Centered Research, Study Approaches
Topic Subcategory
Health State Utilities, Patient-reported Outcomes & Quality of Life Outcomes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology