A Study Evaluating the Efficacy of PD-1 Inhibitor Combined With Denosumab and Chemotherapy in Locally Advanced or Metastatic Non-Squamous Non-Small Cell Lung Cancer Patients With Driver Gene-Negative Status

Inclusion Criteria:

• Histologically or cytologically confirmed locally advanced or metastaticnon-squamous non-small cell lung cancer (NSCLC)

• Documented negative for EGFR/ALK/ROS1/BRAFV600E/RET/METex14 mutations by validatedgenomic testing, with no prior targeted therapy and no history of other malignancies

• No previous systemic therapy for advanced/metastatic disease

• At least one measurable lesion per RECIST v1.1

• Eastern Cooperative Oncology Group (ECOG) Performance Status 0-1

• No use of parathyroid hormone/derivatives, calcitonin, osteoprotegerin, mithramycin,or potassium supplements within the past 6 months

• Adequate organ and marrow function

Exclusion Criteria:

• Histologically or cytologically confirmed combined small cell and non-small celllung cancer (mixed histology)

• Any previous systemic anticancer treatment for NSCLC, including chemotherapy,biologics, immunotherapy, or investigational agents

• Prior use of denosumab or any bone-modifying agents (e.g., bisphosphonates)

• Uncontrolled hypocalcemia or hypophosphatemia

• History or current evidence of osteonecrosis of the jaw (ONJ) or osteomyelitis ofthe jaw