When PD-L1 expression is 50% or higher (PD-L1 high), ICI monotherapy and chemoimmunotherapy show similar outcomes in the US Food and Drug Administration pooled analyses.1,2 Except for scenarios, such as high tumor burden or advanced age, clinical guidelines do not recommend 1 treatment over another, and it is unclear what factors influence prescribing of each treatment in the clinical setting.3 This evidence concerns the gene CD274 and neoplasm.