In advanced non-small-cell lung cancer, the benefit of first-line treatment with the checkpoint inhibitor pembrolizumab may hinge on a patient’s smoking history, US oncologists find.

Their study of 1166 patients with advanced non-small-cell lung cancer (NSCLC) treated with the programmed death-1 (PD-1) inhibitor found those who had ever smoked had longer overall survival compared with never-smokers.

“To our knowledge this is the first direct comparison suggesting that smoking status is predictive of overall survival after receiving first-line pembrolizumab monotherapy in a large, nationally representative, real-world US cohort of patients,” the authors wrote.

In the study, led by Dr Vivek Subbiah of the University of Texas MD Anderson Cancer Center in Houston, some 8% of patients had no history of smoking and 82% were current or former smokers.