ORIGINAL RESEARCH article
Front. Oncol.
Sec. Thoracic Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1611528
Combining immune checkpoint inhibitors with thoracic radiotherapy enhances outcomes in advanced non-small-cell lung cancer: A realworld study
Provisionally accepted
Yao Zou1Yichong Chen2
Xiaojuan Zhou2
Youling Gong2Yong Xu2
Bingwen Zou2
Feng Peng2
Meijuan Huang2
Lu You2
Yongmei Liu2*- 1Meishan People's Hospital, Meishan, China
- 2Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Guoxuexiang Street No. 37, Chengdu 610041, the People’s Republic of China, Chengdu, China
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We aimed to evaluate the efficacy of thoracic radiotherapy (TRT) combined with immune checkpoint inhibitors (ICIs) in patients with advanced non-small-cell lung cancer (NSCLC) in real-world clinical settings and identify predictive subgroups that may benefit most from this approach.We retrospectively reviewed the medical records of patients with advanced NSCLC who were treated with ICIs at West China Hospital from January 2015 to May 2022.Results: A total of 302 patients with advanced NSCLC were included in this study. Among them, 54.3% (164/302) received ICIs in combination with TRT and were assigned to the TRT+ICIs group, while 45.7% (138/302) received ICIs alone and were assigned to the ICIs-only group. The median overall survival (OS) was significantly longer in the TRT+ICIs group (34.7 months) than in the ICIsonly group (27.1 months; P = 0.016). Additionally, the 24-month and 36-month OS rates were notably higher in the TRT+ICIs group (63.7% and 49.0%, respectively) than in the ICIs-only group (55.1% and 16.2%). Subgroup analysis of OS between the TRT+ICIs and ICIs-only groups identified factors associated with improved survival, including male sex, former smoking, Eastern Cooperative Oncology Group (ECOG) performance status 0-1, stage Ⅲb-c, high albumin level, and low neutrophil-to-lymphocyte (NLR) level. Multivariate analysis identified receipt of TRT, programmed death-ligand 1 (PD-L1) expression < 1%, PD-L1 ≥ 50%, and NLR as statistically significant independent prognostic factors for OS (P < 0.05). The combination treatment was well-tolerated, with an acceptable safety profile. Conclusion: Our findings suggest that adding TRT to immunotherapy improves survival outcomes in patients with advanced NSCLC.
Keywords: Immune Checkpoint Inhibitors1, thoracic radiotherapy2, non-small cell lung cancer3, Real-world study4, survival outcomes5
Received: 14 Apr 2025; Accepted: 11 Jul 2025.
Copyright: © 2025 Zou, Chen, Zhou, Gong, Xu, Zou, Peng, Huang, You and Liu. 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: Yongmei Liu, Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Guoxuexiang Street No. 37, Chengdu 610041, the People’s Republic of China, Chengdu, China
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