ArticleAnnals of surgical oncology2025
Lack of Survival Benefit with Immunotherapy in Combination with Adjuvant Chemoradiation in Pathologic Stage II-IIIB Non-small Cell Lung Cancer.
Article in Annals of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- ASO Author Reflections: Examining the Outcomes of Adding Immunotherapy to Adjuvant Chemoradiation in Pathologic Stage II-IIIB Non-Small Cell Lung Cancer.Annals of surgical oncology · 2025Article
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6 authors.
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Abstract
backgroundCurrently, atezolizumab and pembrolizumab are standard management for curatively resected stage II-III non-small cell lung cancer (NSCLC) owing to prior studies showing that they improve disease-free survival. However, these studies excluded the planned use of adjuvant radiation therapy. Survival benefit of adding immune checkpoint inhibitor (ICI) in patients treated with adjuvant chemoradiation (CT+RT) has not been fully assessed.
methodsUsing National Cancer Database (NCDB), we identified and, based on therapy received, stratified 4,934 cases involving patients undergoing complete resection with pathologic stage II-IIIB NSCLC who survived at least 1 month without neoadjuvant CT or RT and subsequently received adjuvant chemotherapy. Kaplan-Meier methods and multi-variable Cox regression models were used for survival analysis. Propensity score matching was performed to compare adjuvant CT+RT+ICI vs. CT+RT. A p-value of <0.05 was considered statistically significant.
resultsThe addition of ICI to adjuvant CT improved overall survival (OS) (2-year OS 90.1% vs. 86%, univariate and multivariate hazard ratios [HRs] 0.72 and 0.66, p = 0.0024 and 0.0003, respectively). However, no OS benefit was seen in those who received adjuvant CT+RT (2-year OS 77.8% vs. 76.1%, univariate and multivariate HRs 0.83 and 0.85, p = 0.3677 and 0.4369, respectively). Propensity score matching analysis showed similar results (2-year OS 77.8% vs. 79.6%, univariate and multivariate HRs 0.91 and 0.87, p = 0.7143 and 0.5868, respectively).
conclusionsOur retrospective real-world analysis suggests that adjuvant ICIs do not improve survival outcome when combined with adjuvant CT+RT. This result mirrors recent negative trials studying ICI+CT+RT in unresectable stage III NSCLC and limited-stage SCLC. Further investigations are warranted.
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