ALK and non-small cell lung carcinoma: However, long-term effectiveness and safety in real-world populations remain underexplored.<h4>Methods</h4>We systematically searched PubMed, Embase, and the Cochrane Library through February 2025 for real-world studies reporting outcomes of first-line pembrolizumab monotherapy in patients with advanced NSCLC and PD-L1 ≥ 50%, excluding those with EGFR/ALK alterations.