Survival Outcomes and Toxicity of Adjuvant Immunotherapy After Definitive Concurrent Chemotherapy With Proton Beam Radiation Therapy for Patients With Inoperable Locally Advanced Non-Small Cell Lung Carcinoma

Authors

Kelsey L Corrigan
Ting Xu
Yuki Sasaki
Ruitao Lin
Aileen B Chen
James W Welsh
Steven H Lin
Joe Y Chang
Matthew S Ning
Saumil Gandhi
Michael S O'Reilly
Carl M Gay
Mehmet Altan
Charles Lu
Tina Cascone
Efstratios Koutroumpakis
Ajay Sheshadri
Xiaodong Zhang
Li Liao
X Ronald Zhu
John V Heymach
Quynh-Nhu Nguyen
Zhongxing Liao

Publication Date

4-1-2024

Journal

Radiotherapy Oncology

Abstract

Introduction: Adjuvant immunotherapy (IO) following concurrent chemotherapy and photon radiation therapy confers an overall survival (OS) benefit for patients with inoperable locally advanced non-small cell lung carcinoma (LA-NSCLC); however, outcomes of adjuvant IO after concurrent chemotherapy with proton beam therapy (CPBT) are unknown. We investigated OS and toxicity after CPBT with adjuvant IO versus CPBT alone for inoperable LA-NSCLC.

Materials and methods: We analyzed 354 patients with LA-NSCLC who were prospectively treated with CPBT with or without adjuvant IO from 2009 to 2021. Optimal variable ratio propensity score matching (PSM) matched CPBT with CPBT + IO patients. Survival was estimated with the Kaplan-Meier method and compared with log-rank tests. Multivariable Cox proportional hazards regression evaluated the effect of IO on disease outcomes.

Results: Median age was 70 years; 71 (20%) received CPBT + IO and 283 (80%) received CPBT only. After PSM, 71 CPBT patients were matched with 71 CPBT + IO patients. Three-year survival rates for CPBT + IO vs CPBT were: OS 67% vs 30% (P < 0.001) and PFS 59% vs 35% (P = 0.017). Three-year LRFS (P = 0.137) and DMFS (P = 0.086) did not differ. Receipt of adjuvant IO was a strong predictor of OS (HR 0.40, P = 0.001) and PFS (HR 0.56, P = 0.030), but not LRFS (HR 0.61, P = 0.121) or DMFS (HR 0.61, P = 0.136). There was an increased incidence of grade ≥3 esophagitis in the CPBT-only group (6% CPBT + IO vs 17% CPBT, P = 0.037).

Conclusion: This study, one of the first to investigate CPBT followed by IO for inoperable LA-NSCLC, showed that IO conferred survival benefits with no increased rates of toxicity.

Keywords

Humans, Aged, Carcinoma, Non-Small-Cell Lung, Proton Therapy, Chemotherapy, Adjuvant, Lung Neoplasms, Immunotherapy, Retrospective Studies

DOI

10.1016/j.radonc.2024.110121

PMID

38311031

PMCID

PMC10947851

PubMedCentral® Posted Date

4-1-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes