National Cancer Database study of real-world outcomes with radiation after chemoimmunotherapy for stage III non-small cell lung cancer

Radiation following chemoimmunotherapy is not currently a standard treatment approach for stage III non-small cell lung cancer (NSCLC). However, a need for this scenario may arise in patients who underwent neoadjuvant chemoimmunotherapy but ultimately no resection. Analysis of the National Cancer Database (NCDB) evaluated real-world outcomes with radiation after chemoimmunotherapy as a nonsurgical option for stage III NSCLC patients diagnosed between 2018 and 2022. In total, 1293 stage III patients received chemoimmunotherapy followed by radiation, while 5382 received chemoradiotherapy followed by immunotherapy, 1921 received chemoimmunotherapy, and 745 received chemoimmunotherapy followed by surgery. Most (n=1145) chemoimmunotherapy followed by radiation patients received a total radiation dose of ≥ 54 Gy, and 90-day mortality after radiation was 5.3%. Chemoimmunotherapy followed by radiation patients were more often staged T4 (41.5% versus 34.8%; p<0.001) or N# (26.2% versus 20.5%; pxtagstartz0.001) compared to chemoradiotherapy/immunotherapy. Three-year overall survival rate with radiation after chemoimmunotherapy was 51.7%, compared was 37.3% with chemoimmunotherapy alone, 56.0% with chemoradiation-immunotherapy, and 81.5% with chemoimmunotherapy-surgery. The authors conclude that radiation after chemoimmunotherapy appears to be a substantially utilized, safe, and potentially effective regimen for stage III NSCLC.