Atezolizumab and stereotactic body radiotherapy in patients with advanced non‐small cell lung cancer: safety, clinical activity and ctDNA responses—the ComIT‐1 trial

Abstract

The introduction of immune checkpoint inhibitors has transformed the treatment landscape of metastatic non-small cell lung cancer. However, challenges remain to increase the fraction of patients achieving durable clinical responses to these drugs and to help monitor the treatment effect. In this phase II trial, we investigated the toxicity, systemic responses and circulating tumour DNA responses in patients (n = 21) with advanced nonsmall-cell lung cancer treated with atezolizumab and stereotactic body radiotherapy in the second or later line. We found the combined treatment to be safe with grade 3 toxicity reported in three patients. As the best overall response, four patients had a partial response, eight had stable disease and five had progressive disease. Median overall survival time was still not reached after a median follow-up of 26.5 months and 10/15 patients with programmed death-ligand 1 negative tumours were alive >18 months after the start of the study treatment. ctDNA was detectable at baseline in 11 patients. A rapid decline in ctDNA to <30% of baseline levels was seen in three patients, two of which were radiographic responders and one was considered clinically benefiting from therapy for almost 1 year.

Evaluation safety and efficacy of immune checkpoint blockers (ICB) and radiotherapy combination versus ICB in non‐small cell lung cancer patients with recurrence or metastasis: A systematic review and meta‐analysis

“…We retrieved 2798 records from three databases, of which 709 duplicated records were excluded. After a series of filters, eventually, 25 journal articles 6 , 7 , 8 , 9 , 10 , 11 , 12 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 were included for the present meta‐analysis. In some articles, two or more arms of combined treatment of ICB + RT in articles were analyzed separately in our meta‐analysis.…”

“…Results of the meta‐analysis in 10 studies 6 , 7 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 comparing ICB plus RT with ICB were performed in Figure 2 , ICB combined with RT was better than without it both in short‐term and long‐term efficacy without increased toxicity. ORR, DCR, OS, and PFS were significantly inferior in patients with combination therapy ( I 2 = 0.00%, OR 1.31, 95% CI 1.13–1.52, I 2 = 0.00%, OR 1.13, 95% CI 1.02–1.26, I 2 = 42.1%, OR 0.81, 95% CI 0.72–0.92, I 2 = 34.5%, OR 0.80, and 95% CI 0.71–0.89, respectively).…”