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Researchers are evaluating the safety and effectiveness of trastuzumab deruxtecan T-DXd Enhertu4 combined with pembrolizumab compared to platinum-based chemotherapy combined with pembrolizumab for people with locally advanced unresectable or metastatic non-squamous non-small cell lung cancer NSCLC that overexpresses HER2 and has PD-L1 tumor proportion score less than 50%. Participants must not have received prior therapy for this condition and should not have known actionable genomic alterations with locally available treatments. Participants are randomly assigned to one of two treatment groups. One group receives T-DXd intravenously at 5.4 mgkg every three weeks plus pembrolizumab 200 mg IV every three weeks. The other group receives pemetrexed 500 mgm2 IV plus a platinum chemotherapy agent cisplatin 75 mgm2 or carboplatin AUC 5 mgmLmin IV every three weeks along with pembrolizumab 200 mg IV every three weeks. Treatments continue as first-line therapy for advanced or metastatic disease. During the study, participants will have tumor tissue samples assessed for HER2 and PD-L1 expression. Researchers will monitor progression-free survival by imaging review up to about 54 months and overall survival up to about 85 months. The trial is open-label and randomized, with assessments including safety monitoring and efficacy evaluations. Participants are followed throughout treatment and for a long-term period to measure outcomes related to disease progression and survival.