Abstract 504P
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
Parameter | NACT+I/O group (n=44) | NACT-Only group (n=37) |
Median Age (IQR) | 59 (49-65) | 61 (54-64) |
MaleFemale | 368 | 343 |
AdenocarcinomaSquamousMixed | 19205 | 11233 |
StageIIIAIIIBIIIC | 72413 | 11206 |
Local Therapy RadiotherapySurgeryNil | 26513 | 22413 |
Last follow-up No diseasePartial responseStable diseaseProgressive diseaseDead | 1241378 | 30101311 |
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.
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