Comparison of efficacy and safety of first-line treatment options for unresectable stage III non-small cell lung cancer: a retrospective analysis

Abstract Background:Based on PACIFIC trail, durvalumab as consolidation therapy following concurrent chemoradiotherapy (cCRT) has been a new standard treatment for unresectable stage III non-small cell lung cancer (NSCLC). In clinical applications, there are heterogeneous adjustments or novel strategies following specialized discussions in experienced multidisciplinary teams. This study retrospectively compared the efficacy and safety of different first-line treatments for unresectable stage III NSCLC. Methods:We retrospectively analyzed 397 patients who received first-line treatment for unresectable stage III NSCLC. Comparisons and statistical analyses of treatment were made in terms of efficacy and safety. Adverse events and responses were assessed using CTCAE v5.0 and RECIST v1.1. The progression-free survival (PFS) wasestimated using the Kaplan-Meier method or Cox survival regression model and compared using the log-rank test. Results:In wild type driver genes group, the objective response rate (ORR), disease control rate (DCR) and median PFS (mPFS) were prolonged in the radiotherapy group than in the non-radiotherapy group (ORR: 50.94% vs. 30.06%, p＜0.001; DCR: 98.11% vs. 80.37%, p＜0.001; mPFS: 21.00 vs. 8.20 months, p＜0.001). The incidence of pneumonia at any grade in the radiotherapy group was higher than that in the non-radiotherapy group (9.43% vs. 2.45%, p=0.008). In the radiotherapy group, the chemoradiotherapy (CRT) plus immunotherapy subgroup had longer mPFS than the CRT subgroup, with increased toxicity at any grade (24.60 vs. 17.90 months, p=0.025; 83.17% vs. 65.52%, p=0.011). In the non-radiotherapy group, the DCR and mPFS were higher in the chemotherapy plus immunotherapy subgroup than in the chemotherapy subgroup, with increased toxicity at any grade (DCR: 93.67% vs. 67.86%, p＜0.001; mPFS: 13.53 vs. 5.07 months, p＜0.001; 68.35% vs. 41.67%, p=0.001). In mutant driver genes group, the efficacy did not significantly differ among radiotherapy subgroup, targeted therapy subgroup and radiotherapy plus targeted therapy subgroup (ORR: p=0.633; mPFS: p=0.450). Conclusions: For unresectable stage III NSCLC patients with wild type driver genes, the combination of radiotherapy and immunotherapy in the initial treatment were essential to significantly improve the efficacy. For patients with mutant driver genes, radiotherapy, targeted therapy, and the combination of radiotherapy and targeted therapy showed similar short-term efficacy..

Medienart:	Preprint

Erscheinungsjahr:	2023
Erschienen:	2023

Enthalten in:	ResearchSquare.com - (2023) vom: 28. Nov. Zur Gesamtaufnahme - year:2023

Sprache:	Englisch

Beteiligte Personen:	Zhao, Luqing [VerfasserIn] Zhao, Zhiting [VerfasserIn] Yan, Xiaoqi [VerfasserIn] Wu, Fei [VerfasserIn] Sun, Ning [VerfasserIn] Guo, Renhong [VerfasserIn] Hu, Xiao [VerfasserIn] Feng, Jifeng [VerfasserIn] Yu, Shaorong [VerfasserIn]

Links:	Volltext [kostenfrei]

Themen:	570 Biology

doi:	10.21203/rs.3.rs-3402054/v2

funding:
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PPN (Katalog-ID):	XRA041688937