This study tests if combining **ramucirumab** and **pembrolizumab** helps treat **stage IV** or **recurrent non-small cell lung cancer (NSCLC)** better than regular chemotherapy. Stage IV means cancer has spread to other parts of the body, and recurrent means cancer has returned after getting better. Ramucirumab is a type of medicine called a **monoclonal antibody** that can stop new blood vessels from growing, which tumors need. Pembrolizumab is another monoclonal antibody that helps the body's immune system fight cancer. Patients are given either the new combination or standard chemotherapy to see which works better. The **main goal** is to compare how long patients live with these treatments. The study also checks for any unexpected serious side effects in each treatment group. Patients must be adults (18+ years) with confirmed stage IV or recurrent NSCLC and must have received prior treatments including **immunotherapy** and **platinum-based chemotherapy**.

• This study involves getting medicine through an IV (a tube into a vein).
• Participants must not be on other experimental treatments during this study.
• This study will compare two different treatment groups.