Abstract 119P
Background
Recent trials of IO prior to resection in locally advanced NSCLC report high rates of pathological response. However, primarily irresectable patients were excluded from most studies. Moreover, there is no data on chemo-radiotherapy (CRT) after IO in patients who are primarily not amenable to CRT. We hypothesized that induction IO may enable more NSCLC patients to receive curative treatment.
Methods
We enrolled 78 patients with borderline resectable NSCLC including 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. 1° endpoint was the proportion of patients completing curative treatment. 2° endpoints included response and survival. Furthermore, pathological response was assessed in resected patients. Exploratory endpoints included the predictive role of PD-L1-TPS and the TP53-mutation status.
Results
73 patients (94%) received curative treatment (32 complete resections, 41 CRT). 18 (56%) of resected patients had a major pathological response including 13 (41%) with pathological complete response. In curatively treated patients, there were 23 recurrences (32%) and 15 tumor-related deaths (21%): 5 recurrences (16%) and no deaths in resected patients, and 18 recurrences (44%) and 15 (37%) deaths in CRT-patients (median follow-up 18 months). There were two treatment-related deaths (one postoperative due to sepsis, one after CRT due to pneumonitis). Patients with high PD-L1-TPS had deeper pathological response and longer survival. Resected patients with TP53-mutation had poorer pathological response and numerically more recurrences than those without TP53-mutation.
Conclusions
In patients with borderline resectable NSCLC including oligometastatic disease, induction IO resulted in a high rate of curative treatment with promising survival. Resected patients achieved a high rate of prognostically favorable pathological response.
Clinical trial identification
NCT04926584.
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, Invited Speaker: MSD, AstraZeneca, Gilead, Roche, Daiichi Sankyo, Mirati, Revolution Medicines. S. Kramberg: Financial Interests, Personal, Invited Speaker: Roche. All other authors have declared no conflicts of interest.