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Non-small cell lung cancer (NSCLC) remains the predominate cause of cancer-related death worldwide. The estimate in the last decade indicates that for patients with metastatic NSCLC, the overall 5-year survival rate is only 7%. It is worthy that molecular target therapies or immunotherapy enable patients with metastatic lung cancer to prolong overall survival and associated with less frequent adverse events. However, chemotherapy alone, such as docetaxel, is correlated with limited efficacy and inevitable toxicity. Although cytotoxic chemotherapy still plays a vital role in cancer interventions, the biomarker-directed therapies that target the molecular alterations or programmed cell death 1 (PD-L1) and programmed cell ligand 1 (PD-1) pathways have substituted for chemotherapy as the standard first-line or second-line therapies for nearly half of patients with advanced NSCLC. An identifiable biomarker that predicts the efficacy of immune checkpoint blockades and tyrosine kinase inhibitors (TKIs) is necessary to determine the patients who most probably benefit from immunotherapy. Evaluating the PD-L1 expression level and workable molecular alterations may be the best prediction indicator for efficacy in NSCLC. This review summarizes the effectiveness in current clinical trials guiding the patients with NSCLC using checkpoint blockades and TKIs as first-line treatment, evaluating the survival efficacy of PD-L1 expression level in selected patients treated with checkpoint blockades. Sixty-three articles about clinical trials of immunotherapy for NSCLC were identified from PubMed. All included articles were published from January 1, 2007, to January 30, 2021, and divided into different PD-L1 expression levels to analyze survival.
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