Trial shows timing matters when adding immunotherapy to chemoradiation for limited-stage small cell lung cancer

Medical Xpress / American Society for Radiation Oncology (ASTRO) Annual Meeting ^ | Sept. 30, 2024 | Kristin Higgins, MD. et al

[ConservativeMind]

People with limited-stage small cell lung cancer may benefit from adding immunotherapy to chemoradiation, but not if both treatments are given at the same time, new research finds.

Findings of the multi-institutional Phase III trial, which also found that twice-daily radiation treatments offer greater survival benefits than once-daily treatment, were presented.

The research comes on the heels of a recent study showing immunotherapy given after radiation and chemotherapy are completed can increase overall survival.

Researchers in this new study, the NRG Oncology/Alliance LU005 trial, wanted to test whether there would be a similar benefit when delivering the treatments at the same time.

Earlier this year, the landmark phase III ADRIATIC trial found adding a similar immunotherapy agent (durvalumab) six weeks after completion of chemoradiation reduced patients' risk of death by 27%.

All patients received radiation therapy either twice daily to a total dose of 45 Gy (47.2% of participants) or once daily to a dose of 66 Gy, as well as four cycles of concurrent chemotherapy.

Contrary to expectations, concurrent treatment with atezolizumab and chemoradiation did not improve survival rates compared to standard care. After one year, overall survival for patients receiving chemoradiation alone was 82.6%, compared to 80.2% with concurrent chemoradiation and atezolizumab.

At two years post-treatment, the rates were 62.9% and 58.6%, respectively, and after three years, 50.3% and 44.7%. Median overall survival for patients on the standard treatment arm was 39.5 months, compared to 33.1 months for those who also received immunotherapy (HR=1.1, 95% CI: 11.3-18.2).

There was a benefit to giving radiation twice daily over giving it once daily. In both groups, patients treated twice daily lived longer on average; median overall survival for those treated twice daily was 35.4 months, compared to 28.3 months for people treated once per day (HR=1.44, 95% CI: 1.10-1.89).

[ConservativeMind]

Two benefits here. One, dual treatments a day with overall lower daily radiation was better than higher single daily radiation. Also, delaying immunotherapy was much better.

[ConservativeMind]

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[UB355]

I am receiving Keytruda after radiation/chemo. Treatment has been successful thankfully.