Using Induction Chemoimmunotherapy as a Bridge to Definitive Local Therapy for Non-Metastatic NSCLC: Real-World...

Induction chemoimmunotherapy is increasingly used for select early-stage and locally advanced non-small cell lung cancer (NSCLC), but real‑world treatment patterns and outcomes remain poorly defined.

We analyzed patients with stage I-III NSCLC enrolled on a single-institution registry and treated with induction chemoimmunotherapy. Both surgical and non-surgical candidates, based on baseline evaluation, were included. For patients treated with definitive surgery or radiotherapy after induction chemoimmunotherapy, overall survival (OS) and progression free survival (PFS) were calculated from the time of surgery or the completion of radiotherapy, respectively.

Of the 168 patients identified, 72 (43%) were clinical stage III, 144 (86%) were surgical candidates at baseline, and 6 (4%) experienced disease progression during induction chemoimmunotherapy. Following induction chemoimmunotherapy, 115 (68% [or 80% of baseline surgical candidates]) underwent surgical resection, 44 (26%) received fractionated radiotherapy (FRT) as either conventional fractionation with chemotherapy (n = 30) or hypofractionation without chemotherapy (n = 14), 4 (2%) received stereotactic body radiotherapy, and 5 (3%) did not receive definitive local therapy. Maintenance immunotherapy was started for 29% of post-surgical patients and 61% of post-FRT patients, although its use was not associated with significant improvements in OS or PFS. OS and PFS also did not differ between FRT regimens.

Our findings demonstrate that induction chemoimmunotherapy is being adopted across a broad NSCLC population and can effectively bridge patients to various definitive therapy strategies. Variability in maintenance immunotherapy use and radiotherapy strategies highlights the need for prospective studies to define optimal treatment approaches.