Multicenter prospective trial of risk-adapted radioimmunotherapy for locally advanced non-small cell lung cancer

Standard therapy for locally advanced non-small cell lung cancer (LA-NSCLC) is concurrent chemoradiotherapy followed by adjuvant durvalumab. A multicenter prospective trial in the USA evaluated sequential pembrolizumab and risk-adapted radiotherapy, without chemotherapy, for biomarker-selected patients with LA-NSCLC. The study included patients with LA-NSCLC with a PD-L1 tumor proportion score ≥ 50%, who received three pembrolizumab induction cycles followed by radiotherapy (55 Gy to tumors or lymph nodes with metabolic volume exceeding 20 cc; 48 Gy to smaller lesions), followed by pembrolizumab consolidation to complete a one-year treatment course. After induction, 48% of patients had partial or complete response. The one-year PFS rate (primary end point) was 76%. One- and two year OS rates were 92% and 76%, respectively. There were no grade 4 or 5 treatment-related adverse events. The authors conclude that among patients with LA-NSCLC with a PD-L1 TPS of ≥ 50%, pembrolizumab and risk-adapted radiotherapy represented a promising treatment approach.