Abstract
The present study evaluated the impact of prior radiotherapy (RT) on patients with advanced non-small cell lung cancer (NSCLC) receiving therapy with immune checkpoint inhibitors (ICIs) and further assessed the prognostic factors in patients receiving both RT and ICI. Patients diagnosed with NSCLC at the Catholic Medical Center and Asan Medical Center between January 2016 and October 2020 and who received immunotherapy were retrospectively reviewed. Among 240 patients, poor Eastern Cooperative Oncology Group (ECOG) score, high PD-L1 expression, and ICI-related adverse events (AE) were significantly associated with progression-free survival (PFS) (HR, 2.654; 95% CI, 1.484–4.749; p = 0.001; HR, 0.645; 95% CI, 0.449–0.926, p = 0.017; HR, 0.430; 95% CI, 0.229–0.808; p = 0.009, respectively). Among patients who received both RT and immunotherapy, poor ECOG status, squamous cell carcinoma, and ICI-related AE were significant factors associated with poor PFS (HR, 2.430; 95% CI, 1.464–4.034; p = 0.001; HR, 0.667; 95% CI, 0.455–0.978, p = 0.038; HR, 0.520; 95% CI, 0.284–0.953, p = 0.034, respectively). The present study showed that prior RT showed no significant independent association with primary outcomes in patients with advanced NSCLC receiving immunotherapy. In patients who received both RT and immunotherapy, clinical parameters, including ICI-related AEs, were independently predictive of PFS.
Highlights
Lung cancer is one of the major causes of cancer-related deaths [1,2], and non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancer cases [3]
The present study evaluated the impact of prior RT in patients with advanced NSCLC
Good Eastern Cooperative Oncology Group (ECOG) score, high PD-ligand 1 (PD-L1) expression, and Immune checkpoint inhibitors (ICIs)-adverse events (AE) were significantly associated with longer progression-free survival (PFS) (HR: 2.654, 95% confidence intervals (95% CIs): 1.484–4.749, p = 0.001; Hazard ratios (HRs): 0.645, 95% CI: 0.449–0.926, p = 0.017; HR: 0.430, 95% CI: 0.229–0.808, p = 0.009, respectively)
Summary
Lung cancer is one of the major causes of cancer-related deaths [1,2], and non-small cell lung cancer (NSCLC) accounts for 85% of all lung cancer cases [3]. In addition to improved patient outcomes, the trial showed a slight increase in toxic effects in the durvalumab group compared with the placebo arm; the rates of severe immune-related adverse events, pneumonitis in particular, were not significantly different. Patients showed lower disease recurrence when durvalumab was initiated within ≤2 weeks of the last radiation dose rather than being initiated >2 weeks after radiation This may suggest that a short window between. Various studies have shown that subsequent or concurrent RT and immunotherapy did not increase the risk of anti-PD-1-related toxicities [19,21,22], additional data on the combination treatment are necessary to better demonstrate the clinical impact and safety profile of the combination treatment, as the sample size of the populations varied and heterogeneity in terms of clinical characteristics was present
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