Survival Analysis of Patients with Locally Advanced Non-Small Cell Lung Cancer Who Received Neoadjuvant Immunotherapy

Abstract

In the PACIFIC study, immuno-consolidation therapy has a great survival benefit for patients with locally advanced non-small cell lung cancer who had no progression after concurrent chemoradiotherapy. However, there is no clear evidence that earlier immunotherapy intervention can obtain better survival benefits for patients with progression after concurrent or sequential chemoradiotherapy. The purpose of this retrospective study was to further explore impact of early intervention in immunotherapy on survival. All patients who were treated with concurrent or sequential chemoradiotherapy and immunotherapy for LA-NSCLC between September 2019 and December 2021 were eligible. Time-to-event data were assessed by using the Kaplan-Meier estimator, and the Cox proportional hazards model was used for prognostic factor analyses. According to the timing of immunotherapy use, 60 patients with LA non-small cell lung cancer were divided into neoadjuvant group and consolidation group, with 30 patients in each group. All patients completed concurrent or sequential chemoradiotherapy. The median follow-up time in the neoadjuvant and consolidation groups was 20 and 18 months. In the neoadjuvant group, 4 patients died, 15 patients developed tumor progression, and 5 patients had distant metastasis. In the consolidation group, 5 patients died, 15 patients developed tumor progression, and 4 patients had distant metastasis. The median PFS of the neoadjuvant group and the consolidation group were 19 months and 15 months (P = 0.703). Both groups did not reach the median OS. The 1-year and 2-year PFS rates were 72.9%, 63.3% and 41.0%, 48.1%. 1-year and 2-year OS rate were 93.0%, 93.3%, and 74.4%, 76.6%. Disease control rates (DCR) in the both neoadjuvant and consolidation groups were 90%. There was little difference in the incidence of adverse responses between the two groups. Earlier immune intervention may have resulted in treatment effects similar to those observed in the PACIFIC trial, which suggests that the benefits of immunotherapy could be extended to a broader population.