ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1591134
This article is part of the Research TopicAdvancing NSCLC Treatment: Overcoming Challenges in Immune Checkpoint Inhibitor TherapyView all 14 articles
Induction chemoimmunotherapy may achieve non-inferior outcomes to consolidation immunotherapy in patients with unresectable stage III NSCLC: a real-world multicenter retrospective study
Provisionally accepted
- 1Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- 2Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, Beijing Municipality, China
- 3Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Background: Consolidation immunotherapy after chemoradiotherapy (CRT) is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). However, the role of upfront chemoimmunotherapy before CRT remains unclear. This study aims to investigate the value of induction chemoimmunotherapy before CRT in unresectable stage III NSCLC.Methods: Unresectable stage III NSCLC patients who received induction chemoimmunotherapy before CRT or consolidation immunotherapy after CRT from four centers were retrospectively enrolled. The Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS), and one-to-one propensity score matching (PSM) was used to further minimize confounding.Results: A total of 262 patients were enrolled, with 124 (47.3%) receiving induction chemoimmunotherapy (Ind group) and 138 (52.7%) receiving consolidation immunotherapy (Con group). Further 1:1 PSM analysis showed that induction chemoimmunotherapy achieved comparable outcomes to consolidation immunotherapy (2-year PFS: 56.0% vs. 45.6%, P=0.327; 2-year OS: 81.0% vs. 79.2%, P=0.960) with fewer cycles of immunotherapy (median 4 vs. 10 cycles, P<0.001). The incidence of treatment-related adverse events was similar (P>0.05). Exploratory analysis found that patients with < 4 cycles of induction immunotherapy had similar PFS (median NR vs. 30.1 months, 2-year PFS 50.8% vs. 54.4%, P=0.932) but prolonged OS (median NR vs. 46.0 months, 2year OS 89.0% vs. 75.5%, P=0.112) compared to those with ≥ 4 cycles of induction immunotherapy.Upfront chemoimmunotherapy before CRT appears to be feasible and safe, and may achieve non-inferior outcomes to consolidation immunotherapy with fewer cycles of immunotherapy.
Keywords: chemoradiotherapy 1, Consolidation immunotherapy 2, Induction chemoimmunotherapy 3, non-small cell lung cancer 4, Prognosis 5
Received: 10 Mar 2025; Accepted: 26 May 2025.
Copyright: © 2025 Guan, Wang, Liu, Yan, Ren, Wang, Bi and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jun Wang, Department of Radiotherapy, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
Nan Bi, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng, 100006, Beijing Municipality, China
Lujun Zhao, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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