Fu Zhixue, Dong Xin, Sun Jiawen, Deng Wei, Zhao Yuting, Yang Dan, Jiang Leilei, Chang Xiao, Yu Rong, Shi Anhui, Yu Huiming, Wang Jidong, Jiang Wei, Lu Jiawei, Chen Dongjie, Liang Jun, Wang Weihu
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
Department of Radiation Oncology, Peking University International Hospital, Beijing, China.
Front Immunol. 2025 Jul 31;16:1602082. doi: 10.3389/fimmu.2025.1602082. eCollection 2025.
For unresectable stage III non-small cell lung cancer (NSCLC), the standard regimen is definitive concurrent chemoradiotherapy (CRT) followed by consolidation immunotherapy. We investigated whether incorporating induction immunochemotherapy enhances the efficacy.
From June 2018 to December 2022, 294 patients with unresectable stage III NSCLC were included, who did (162, I-CRT-I group) or did not (132, CRT-I group) receive induction immunochemotherapy, followed by definitive CRT and consolidation immunotherapy. Propensity score matching (PSM) adjusted for potential confounding variables. Overall survival (OS), progression-free survival (PFS), recurrence pattern, and safety were evaluated.
After PSM, 206 patients (103 in each group) were included. The median follow-up time was 32.3 and 44.6 months for the I-CRT-I and CRT-I group, respectively. The I-CRT-I group showed a significant improvement in OS compared with the CRT-I group (=0.004). The median OS in the I-CRT-I group was not reached, with 1-, 2-, and 3-year OS rates of 91.3%, 80.0%, and 72.9%, respectively; the CRT-I group had a median OS of 39.3 months, with survival rates of 91.1%, 69.3%, and 52.0%, respectively. PFS (=0.332) and local locoregional recurrence (=0.940) were not significantly different between the groups, while significantly lower cumulative distant metastasis (DM) was noted for the I-CRT-I group (=0.004). Prior to PSM, the adverse events rate was 96.3% and 95.5% in the I-CRT-I and CRT-I groups, respectively, with pneumonitis noted in 57.4% and 58.3%, respectively.
Induction immunochemotherapy followed by definitive CRT and consolidation immunotherapy may improve OS and decrease DM, along with manageable safety.
对于不可切除的III期非小细胞肺癌（NSCLC），标准治疗方案是根治性同步放化疗（CRT）后进行巩固性免疫治疗。我们研究了加入诱导免疫化疗是否能提高疗效。
纳入2018年6月至2022年12月期间294例不可切除的III期NSCLC患者，其中162例（I-CRT-I组）接受诱导免疫化疗，132例（CRT-I组）未接受诱导免疫化疗，随后进行根治性CRT和巩固性免疫治疗。采用倾向评分匹配（PSM）对潜在混杂变量进行调整。评估总生存期（OS）、无进展生存期（PFS）、复发模式和安全性。
PSM后，纳入206例患者（每组103例）。I-CRT-I组和CRT-I组的中位随访时间分别为32.3个月和44.6个月。与CRT-I组相比，I-CRT-I组的OS有显著改善（=0.004）。I-CRT-I组的中位OS未达到，1年、2年和3年OS率分别为91.3%、80.0%和72.9%；CRT-I组的中位OS为39.3个月，生存率分别为91.1%、69.3%和52.0%。两组间PFS（=0.332）和局部区域复发（=0.940）无显著差异，而I-CRT-I组的累积远处转移（DM）显著较低（=0.004）。在PSM之前，I-CRT-I组和CRT-I组的不良事件发生率分别为96.3%和95.5%，肺炎发生率分别为57.4%和58.3%。
诱导免疫化疗后进行根治性CRT和巩固性免疫治疗可能改善OS并降低DM，且安全性可控。
