1295P - Prospective trial of immuno-(chemo)therapy prior to resection, definitive chemo-radiotherapy, or palliative therapy in patients with borderline resectable or oligometastatic non-small cell lung cancer (KOMPASSneo)

Background

Recent trials of immuno-(chemo)therapy (IO) prior to resection in locally advanced NSCLC report high rates of pathological response. However, primarily irresectable patients and oligometastatic patients were excluded from most studies. Moreover, there is no data on chemo-radiotherapy (CRT) after immuno-(chemo)therapy in patients who are primarily not amenable to CRT. Induction IO may enable more NSCLC patients to receive curative treatment.

Methods

We enrolled 86 patients with borderline resectable NSCLC including 22 patients with oligometastatic disease into a prospective real-world trial of induction IO followed by morphologic and metabolic reassessment and multidisciplinary board-guided curative treatment (resection [preferred] or CRT) or palliative therapy.

Results

81 patients (94%) received curative treatment (38 resections, 43 CRT). 21 (55%) of resected patients had a major pathological response including 15 (39%) with pathological complete response. In curatively treated patients, there were 25 recurrences (31%) and 18 tumor-related deaths (22%): 6 recurrences (16%) and 1 death in resected patients, and 19 recurrences (44%) and 17 deaths (40%) in CRT-patients. There were 2 treatment-related deaths (postoperative sepsis, pneumonitis after CRT). The table shows survival of the whole population and oligometastatic patients (median follow-up 19.3 months). Table: 1295P

Conclusions

In patients with borderline resectable NSCLC including oligometastatic disease, induction immuno-(chemo)therapy resulted in a high rate of curative treatment with promising survival. Resected patients achieved a high rate of prognostically favorable pathological response. Induction IO should be considered both for patients with stage II – III disease and for patients with oligometastatic disease.

Clinical trial identification

NCT04926584.

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

M. Faehling: Financial Interests, Personal, Advisory Board: AstraZeneca, Roche, BMS, MSD; Financial Interests, Institutional, Coordinating PI: MSD, Roche; Financial Interests, Institutional, Local PI: AstraZeneca, Gilead, Daiichi Sankyo, Mirati, Revolution Medicines. S. Kramberg: Financial Interests, Personal, Expert Testimony: Roche. All other authors have declared no conflicts of interest.