Induction immunochemotherapy followed by definitive radiotherapy for inoperable NSCLC: A retrospectivecohort study

For patients with unresectable stage III non-small cell lung cancer, consolidation immunotherapy after concurrent or sequential chemoradiotherapy has become the standard treatment paradigm. However, in real-world clinical practice, a considerable proportion of patients are unable to tolerate the standard concurrent chemoradiotherapy regimen due to high tumor burden, advanced age, poor performance status, multiple comorbidities, or early toxicities from chemoradiotherapy. These factors not only limit the safe escalation of radiotherapy doses but also increase the risk of treatment-related mortality and severe complications. Therefore, there is an urgent need to explore alternative treatment strategies.

We retrospectively reviewed patients with histologically or cytologically confirmed stage III unresectable non-small cell lung cancer who received treatment at Sichuan Cancer Hospital between January 2022 and August 2024. The primary endpoints are PFS and OS, while the secondary endpoints are ORR and safety.

A total of 87 patients were included. The median follow-up time from the start of induction therapy was 21months. The 1-year PFS rate and OS rate were 70% and 88.5%, respectively. The median PFS and median OS was NR at the time of data cutoff. ORR was 82.8%. Immunotherapy consolidation was associated with both improved PFS and OS. The incidence rate of pneumonia above grade 3 was 8%.

The treatment approach of induction ICIs combined with chemotherapy followed by definitive radiotherapy, with or without consolidation immunotherapy, has shown encouraging efficacy and is safe to administer, but further research is still needed to confirm these findings.