Table 3.

Viewpoints of Each Stance About the Adaptation of Chemotherapy Plus Nivolumab as a First-Line Treatment

Viewpoint	Conflicting Stance
	Limit Use in CPS ≥ 5 (and MSI-H)	Use Regardless of CPS
Efficacy	Limited survival benefits in CPS < 5	OS benefit shown in all comers
Adverse event	Increased toxicities	Manageable toxicities
Post ICI treatment	Availability in later line (Subgroup in Japan)	Not all can receive later-line or not available
Others	Cost performance	Limitations of CPS evaluation (Heterogeneity, sample quality, inter-pathologist variability, difference in antibodies, etc)
Japanese subgroup	No survival benefit in overall all patients in ATTRACTION4 and Japanese subgroup.	–

Abbreviation: CPS, PD-L1 combined positive score.