Efficacy and safety of immune checkpoint inhibitor consolidation after chemoradiation in patients of Asian ethnicity with unresectable stage III non‐small cell lung cancer: Chinese multicenter report and literature review

Abstract

Background: The PACIFIC study has defined a new standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC) in the form of immune checkpoint inhibitor (ICI) consolidation therapy. However, there is little specific data pertaining to the safety and efficacy of this approach in Chinese NSCLC patients. Methods: This was a prospective multicenter cohort study. Between September 2018 and January 2020, patients with unresectable stage III NSCLC that had undergone chemoradiation therapy (CRT) and ICI consolidation treatment were enrolled in this study. The short-term safety, tolerability, and efficacy of ICI combination with CRT were evaluated in these patients. Results: Of the 20 Chinese patients eligible for inclusion, 17 (85.0%) underwent concurrent CRT treatment. In these patients, a median period of 40.5 days (range: 1-85 days) passed between the end of CRT and initiation of consolidation therapy. Pneumonitis occurred in 80.0% of patients, with seven (35.0%) being diagnosed with grade 1 pneumonitis and nine (45.0%) with grade 2 pneumonitis. No patients experienced grade 3 or higher pneumonitis or other ICI-related toxicities. Lung V20 ≥ 20% was associated with higher grade 2 pneumonitis (77.8%; ≥20% vs. 18.2%; <20%, P = 0.027). The overall response rate (ORR) in these patients was 95.0%. Over a median follow-up period of 11.3 months (range: 6.2-21.8 months), 12-month PFS of these patients were 89.5% (95% CI: 76.7-100.0%), and 12 months OS was 100.0%. Conclusions: These data indicate that ICI consolidation therapy can achieve favorable short-term efficacy, while exhibiting good safety and acceptable toxicity profiles in Chinese patients with unresectable stage III NSCLC.

Safety of thoracic radiotherapy after PD‐(L)1 inhibitor treatment in patients with lung cancer

“…Consistently, our results also indicated that V20 was an independent risk factor for occurrence of symptomatic pneumonitis (OR 3.49 p = 0.007; V20 ≥ 16.7% vs. V20 < 16.7%, 67.44% vs. 36.73%). Notably, the cut‐off value of V20 in our analysis was lower than those established in previous studies with range of 20%–35% 15,16,34‐38 . We speculated that this was possibly due to the predisposition of symptomatic pneumonitis in patients receiving TRT after PD‐(L)1 inhibitor treatment, which alerted radiation oncologists to delineate target plan carefully to control total lung V20 in order to minimize the incidence of pneumonitis when chose this sequential regimen.…”

“…The total lung V20 is a crucial and the most frequently described dosimetric parameter generally used to define a specific threshold dose to predict the occurrence of radiation pneumonitis. 15,16,[34][35][36][37][38] cancer who underwent concurrent chemoradiotherapy and evaluated the association between V20 and symptomatic pneumonitis. 15 The results showed that V20 = 25% was an optimal cut-off value to differentiate patients with high risk for development of symptomatic pneumonitis (OR 1.03, p = 0.008).…”

“…The total lung V20 is a crucial and the most frequently described dosimetric parameter generally used to define a specific threshold dose to predict the occurrence of radiation pneumonitis 15,16,34‐38 . For example, Palma et al performed a meta‐analysis of 836 patients with lung cancer who underwent concurrent chemoradiotherapy and evaluated the association between V20 and symptomatic pneumonitis 15 .…”

“…Notably, the cut-off value of V20 in our analysis was lower than those established in previous studies with range of 20%-35%. 15,16,[34][35][36][37][38] We speculated that this was possibly due to the predisposition of symptomatic pneumonitis in patients receiving TRT after PD-(L)1 inhibitor treatment, which alerted radiation oncologists to delineate target plan carefully to control total lung V20 in order to minimize the incidence of pneumonitis when chose this sequential regimen. This study has several limitations.…”

IL-11RA is a Prognostic Biomarker and Correlated with Immune Infiltration in Lung Adenocarcinoma

“…Currently, surgical resection combined with chemotherapy and radiotherapy is a primary method for treating LUAD [3]. In recent years, lung cancer immunotherapy has become a new research hot spot, which can activate the patients' immune system, exert an antitumor effect [4], and improve the clinical symptoms and overall survival [5]. Despite the advance of immunotherapy, the prognosis of patients with LUAD remains poor [6].…”