504P - Real-world outcomes with induction systemic therapy for stage III in eligible for upfront local therapy: Pre vs post immunotherapy era in a tertiary referral centre

Background

Evidence on the role of induction systemic therapy is limited for stage III NSCLC patients who cannot undergo upfront local therapy due to locally extensive disease or baseline poor lung function.

Methods

We analyzed 81 patients with Stage III Non-Oncogene driven NSCLC deemed ineligible for upfront local therapy by Thoracic MDT between September 2015 and January 2023, retrospectively. Of those, 44 patients received a combination of induction chemotherapy (IC) with low-dose immunotherapy (Nivolumab-42; Pembrolizumab-2) as concurrent or maintenance or both (NACT+I/O group) and 37 patients received only IC (NACT-only group) followed by assessment for local therapy. IC was platinum doublet in both groups, median number of cycles was four. Immunotherapy was given as induction only (n=26), maintenance only (n=7) or both (n=11) based on physician preference and practical feasibility. For Nivolumab, 24 patients received >0.6mg/kg q2weekly whereas 18 received <0.6mg/kg q2weekly dose. Outcomes analyzed were proportion of patients undergoing local therapy, median PFS, OS and toxicity data.

Results

Baseline characteristics are outlined in given table. 70% of patients underwent subsequent local therapy in both NACT+I/O and NACT-only groups. Median PFS was 27.5 months in NACT+I/O Group vs 13.7 months in NACT-only group (p=0.01). Median OS was 39.3 months in NACT+I/O Group vs 25.2 months in NACT-only group (p=0.21). Grade ≥3 toxicities observed in NACT + I/O vs NACT groups were hematological (7 vs 2), diarrhea (1 vs 1) and fatigue (1 vs 1). Table: 504P

Baseline characteristics

Conclusions

Induction systemic therapy resulted in the conversion of 70% stage III NSCLC to local therapy in our experience. The use of low-dose immunotherapy along with chemotherapy was safe and yielded a significant PFS benefit and numerically higher OS benefit. This may prove to be a cost-effective option for stage III NSCLC patients ineligible for upfront local therapy, especially in LMIC.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.