Immunotherapy in Non-Small Cell Lung Cancer: A Comprehensive Literature Synthesis

Abstract

This study aims to assess the therapeutic impact of immune checkpoint inhibitors (ICIs) targeting PD-1, PD-L1 and CTLA-4 in non-small cell lung cancer (NSCLC), with particular emphasis on PD-L1–guided treatment strategies and implementation challenges in low- and middle-income countries (LMICs). A structured case-study–based literature synthesis was conducted, including landmark randomized clinical trials, meta-analyses and international guidelines published between 2015 and 2025, retrieved from PubMed, Scopus and Web of Science, focusing on clinical efficacy, immune-related adverse events and biomarker-driven decision-making. The results indicate that ICIs significantly improve overall survival in NSCLC, extending median survival from approximately 8 months with conventional chemotherapy to nearly 24 months in selected patients; therapeutic benefit varies according to PD-L1 expression, favoring monotherapy for PD-L1 ≥50% and chemo-immunotherapy combinations for lower expression levels, while immune-related toxicities and biomarker heterogeneity remain major limitations. From a policy and public-health perspective, LMICs such as Algeria require standardized PD-L1 testing, reinforced multidisciplinary expertise for toxicity management, and adaptive health policies incorporating cost-containment strategies and digital oncology tools to optimize equitable access and maximize the clinical impact of immunotherapy in NSCLC.