Thus far, published phase III NSCLC clinical trials with PD-1 pathway inhibitors in the first-line setting have been restricted to patients with a good Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0 or 1.1–4 However, an estimated 21% of patients with advanced NSCLC have an ECOG PS of 2 at the time of initial diagnosis,5 and little is known about the efficacy of first-line immunotherapy in this population. This evidence concerns the gene PDCD1 and non-small cell lung carcinoma.