# PD-1 blockade + chemotherapy in PD-L1-low NSCLC

Source: https://onco.cc/pairings/pd1-plus-chemo-pdl1-low/  
OnCo record `pd1-plus-chemo-pdl1-low` (Pairing). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

When the tumour shows little PD-L1, immunotherapy alone is weak, but adding chemotherapy makes it work for most patients.

## Summary

This combination gives a PD-1 checkpoint inhibitor together with cytotoxic chemotherapy in non-small-cell lung cancer whose PD-L1 tumour proportion score is low. Chemotherapy releases tumour antigen and depletes suppressive cells, priming an immune response that PD-1 blockade then sustains, and the benefit does not depend on the PD-L1 level. KEYNOTE-189 in non-squamous and KEYNOTE-407 in squamous disease showed an overall survival benefit across PD-L1 strata, including tumours with essentially no PD-L1 expression. POSEIDON adds tremelimumab to durvalumab and chemotherapy for PD-L1-negative and STK11- or KEAP1-mutant disease. Pembrolizumab with chemotherapy is now the standard control arm against which every new first-line lung regimen is measured.

## Fields

- Kind: Pairing
- Last checked: 2026-09-06
- Pairs: Immune checkpoint inhibitors + Cytotoxic chemotherapy
- Type: combination
- Rationale: Chemotherapy releases antigen and depletes suppressive cells, priming a response that PD-1 blockade sustains; benefit is independent of PD-L1 level.
- Evidence: Multiple phase 3 with 5-year OS data.

## Sources

- ClinicalTrials.gov NCT02142738: KEYNOTE-024 & KEYNOTE-189: https://clinicaltrials.gov/study/NCT02142738

## Connected records

- cancers: [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [PD-L1-high non-small-cell lung cancer without a driver mutation](https://onco.cc/cancers/pdl1-high-nsclc/)
- drugs: [Durvalumab](https://onco.cc/drugs/durvalumab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Tremelimumab](https://onco.cc/drugs/tremelimumab/)
- terms: [Tumour proportion score (TPS)](https://onco.cc/terms/tps/)
- trials: [KEYNOTE-024 & KEYNOTE-189](https://onco.cc/trials/keynote-024-189/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/)

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