Standard treatment for patients with inoperable early-stage nonsmall- cell lung cancer (NSCLC) includes stereotactic ablative radiotherapy (SABR). However, regional or distant relapses remain common, according to Joe Y. Chang, MD, PhD.
Although immunotherapy has proven to be an effective treatment in stage III NSCLC, its efficacy in earlier stages remains unknown, according to a study by Dr. Chang and colleagues published in The Lancet. The researcher team conducted a randomized controlled trial to compare the outcomes of SABR alone with SABR combined with immunotherapy (I-SABR) in patients with early-stage NSCLC. The primary outcome was 4-year event-free survival, while the key secondary outcome was the assessment of adverse events associated with treatment.
77% of Patients in I-SABR Group Showed Greater Event- Free Survival
Dr. Chang and colleagues assessed 183 patients for eligibility among three US hospitals between June 30, 2017, and March 22, 2022. The study included adult patients with inoperable early-stage NSCLC or those who had isolated parenchymal recurrences. Altogether, the final analysis included 156 patients (n=78 each in SABR and I-SABR).
The primary outcome of 4-year event-free survival was significantly greater in the I-SABR group (77%) when compared with SABR alone (53%; HR, 0.38, 95% CI, 0.19-0.75; P=0.0056). Moreover, the secondary outcome showed that I-SABR offered improved eventfree survival in early-stage NSCLC with tolerable toxicity. More patients in the I-SABR group experienced grade 3 immunological adverse events related to nivolumab (15% in I-SABR vs 0% in SABR). Overall, findings from this study suggest that physicians can use I-SABR as a treatment option for early-stage NSCLC. According to the study team, I-SABR significantly improved event-free survival at 4 years in patients with early-stage NSCLC, when compared with SABR alone. Although this study was comprehensive, its phase 2 nature created limitations, which warrants further confirmation with larger phase 3 trials.
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