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Updated: Feb 15, 2026

Detection of Targetable Alterations in Non-small Cell Lung Cancer using Next-generation Sequencing
Published on: October 10, 2025
Impact of First-Line Maintenance Immunotherapy With or Without Pemetrexed for Non-Squamous Advanced/Metastatic
Fabio Gomes1, Niall Gilding2, Vivian Tan2
1Christie Hospital, Manchester, UK.
Objectives:
Real-world analyses of first-line maintenance (1LM) immuno-oncology (IO) treatment with or without pemetrexed for patients with non-squamous (NSQ) advanced/metastatic non-small cell cancer (a/mNSCLC), including the relative impact of 1LM pemetrexed, are lacking. This retrospective analysis describes 1LM treatment patterns and their outcomes in England.
Methods:
Data from the National Disease Registration Service were collated to identify 2 cohorts of patients with NSQ a/mNSCLC completing ≥ 4 cycles of first-line (1L) platinum-based chemotherapy with IO plus pemetrexed, diagnosed from 1 March to 31 December 2019 (Cohort 1), or during a period where interim coronavirus disease 2019 (COVID-19) guidelines were in effect (1 March to 31 December 2020; Cohort 2). Baseline characteristics, 1LM treatment, overall survival (OS) and time to next treatment or death in both cohorts, and in a combined cohort of patients receiving 1LM stratified by the presence/absence of 1LM pemetrexed, were analyzed.
Results:
Overall, 595 and 516 NSQ a/mNSCLC patients were included in Cohorts 1 and 2, respectively. Median OS (95% confidence interval [CI], months) from start of 1L was numerically longer in Cohort 1 (19.5 [17.6-22.2] months) versus Cohort 2 (15.7 [14.2-18.0] months). Combined (Cohort 1 and Cohort 2) median OS from 1L was broadly similar irrespective of pemetrexed presence (19.5 [17.5-21.6] months) or absence (18.6 [15.6-23.0] months) in 1LM.
Conclusions:
Survival was numerically shorter for patients diagnosed during the COVID-19 pandemic (Cohort 2; interim guidance) versus Cohort 1 (pre-COVID-19). In a combined cohort, survival was broadly similar regardless of 1LM pemetrexed use.
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