Induction immunochemotherapy followed by definitive chemoradiotherapy for unresectable locally advanced non‐small cell lung cancer: a multi‐institutional retrospective cohort study
Leilei Wu,
Bo Cheng,
Xiaojiang Sun,
Zhenshan Zhang,
Jingjing Kang,
Yun Chen,
Qinghua Xu,
Shuangyan Yang,
Yujie Yan,
Shengxiang Ren,
Caicun Zhou,
Yaping Xu
Affiliations
Leilei Wu
Department of Radiation Oncology Shanghai Pulmonary Hospital School of Medicine Tongji University Shanghai China
Bo Cheng
Department of Radiation Oncology Qilu Hospital Cheeloo College of Medicine Shandong University Jinan China
Xiaojiang Sun
Department of Radiation Oncology Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Institute of Cancer and Basic Medicine (IBMC) Chinese Academy of Sciences Hangzhou China
Zhenshan Zhang
Department of Radiation Oncology Shanghai Proton and Heavy Ion Center Fudan University Cancer Hospital Shanghai China
Jingjing Kang
Department of Radiation Oncology Shanghai Pulmonary Hospital School of Medicine Tongji University Shanghai China
Yun Chen
Department of Radiation Oncology Shanghai Pulmonary Hospital School of Medicine Tongji University Shanghai China
Qinghua Xu
Department of Radiation Oncology Shanghai Pulmonary Hospital School of Medicine Tongji University Shanghai China
Shuangyan Yang
Department of Radiation Oncology Shanghai Pulmonary Hospital School of Medicine Tongji University Shanghai China
Yujie Yan
Department of Radiation Oncology Shanghai Pulmonary Hospital School of Medicine Tongji University Shanghai China
Shengxiang Ren
Department of Medical Oncology Shanghai Pulmonary Hospital School of Medicine Tongji University Shanghai China
Caicun Zhou
Department of Medical Oncology Shanghai Pulmonary Hospital School of Medicine Tongji University Shanghai China
Yaping Xu
Department of Radiation Oncology Shanghai Pulmonary Hospital School of Medicine Tongji University Shanghai China
Abstract This study aimed to evaluate the efficacy and safety of induction immunochemotherapy followed by definitive chemoradiotherapy (CRT) for unresectable locally advanced non‐small cell lung cancer (LA‐NSCLC). We identified unresectable stage III NSCLC patients who received induction immunochemotherapy. Overall survival (OS) and progression‐free survival (PFS) were the primary endpoints. From February 2019 to August 2022, 158 patients were enrolled. Following the completion of induction immunochemotherapy, the objective response rate (ORR) and disease control rate (DCR) were 52.5% and 83.5%, respectively. The ORR of CRT was 73.5%, representing 68.4% of the total cohort. The median PFS was 17.8 months, and the median OS was 41.9 months, significantly higher than in patients who received CRT alone (p < 0.001). Patients with concurrent CRT demonstrated markedly improved PFS (p = 0.012) and OS (p = 0.017) than those undergoing sequential CRT. Additionally, those with a programmed‐death ligand 1 (PD‐L1) expression of 50% or higher showed significantly elevated ORRs (72.2% vs. 47.2%, p = 0.011) and superior OS (median 44.8 vs. 28.6 months, p = 0.004) compared to patients with PD‐L1 expression below 50%. Hematologic toxicities were the primary severe adverse events (grade ≥ 3) encountered, with no unforeseen treatment‐related toxicities. Thus, induction immunochemotherapy followed by definitive CRT demonstrated encouraging efficacy and tolerable toxicities for unresectable LA‐NSCLC.
