Can Immunotherapy After Chemoradiotherapy Improve Outcomes in Clinical Stage III Lung Cancer?

By: Victoria Kuhr, BA
Posted: Tuesday, December 6, 2022

Patients with non–small cell lung cancer (NSCLC) who received immunotherapy after chemoradiotherapy had improved overall survival compared with those who received chemoradiotherapy alone, based on the findings of a cohort study. Additionally, Daniel J. Boffa, MD, MBA, of Yale University, New Haven, Connecticut, and colleagues suggested the multimodality treatment planning of immunotherapy, including the time to initiate treatment, can be flexible. These findings were published in JAMA Network Open.

“Overall, the results of this retrospective cohort study suggest that the benefit of immunotherapy after chemoradiation for stage III NSCLC may extend to the general population in the United States, including patients who are older and those who are socioeconomically disadvantaged,” said the study authors.

The study analyzed data from the National Cancer Database on patients diagnosed with stage III NSCLC between 2015 and 2017, with follow-up through the end of 2018. All patients received multiagent chemotherapy and at least 45 Gy of radiation. The addition of immunotherapy was compared with chemoradiotherapy alone.  

Of the 23,811 patients included in the study, 1,297 received immunotherapy after chemoradiotherapy, and 22,514 received chemoradiotherapy alone. The median patient age was 66 years; 209 patients (16.1%) had multiple comorbidities, and 1,297 (5.4%) were recipients of immunotherapy. The median follow-up was 32.4 months.

The addition of immunotherapy was associated with improved 3-year survival, with 52% of patients receiving immunotherapy after chemoradiotherapy compared with 44% of those receiving chemoradiotherapy alone. Additionally, immunotherapy was associated with improved survival among patients aged 75 and older as well among those on Medicare or Medicaid.

When compared with the PACIFIC trial protocol, 833 patients receiving immunotherapy (64.2%) differed from the protocol. This difference included 221 patients (17.0%) who received radiation doses outside the protocol range, and 731 patients (56.4%) who started immunotherapy more than 6 weeks after radiation therapy was completed. The survival advantage of immunotherapy persisted when initiated up to 12 weeks after radiation therapy was completed.

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.

JAMA Network Open

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