Evidence map›Paper›PMID 41052882›Full record

Trial reportJournal for immunotherapy of cancer2025

Causal AI-based clinical and radiomic analysis for optimizing patient selection in combined immunotherapy and SABR in early-stage NSCLC: a secondary analysis of the phase II I-SABR trial.

Maliazurina B Saad, Eman Showkatian, Vivek Verma, Qasem Al-Tashi, Muhammad Aminu, Xinyan Xu, Muhamed Qayati Mohamed, Morteza Salehjahromi, Sheeba J Sujit, Yuliya Kitsel and 12 more

Abstract readClinical Trial, Phase IIRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal for immunotherapy of cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Article
  2. SARS-CoV-2 mRNA Vaccination Improved Survival in NSCLC Treated With Radiotherapy.Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer · 2026
    Article
  3. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

Maliazurina B Saad *Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Eman Showkatian *Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Vivek VermaDepartment of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Qasem Al-TashiDepartment of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Muhammad AminuDepartment of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Xinyan XuDepartment of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Muhamed Qayati MohamedDepartment of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Morteza SalehjahromiDepartment of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Sheeba J SujitDepartment of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Yuliya KitselDepartment of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Steven H LinDepartment of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.ORCID http://orcid.org/0000-0003-4411-0634
Zhongxing LiaoDepartment of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Saumil GandhiDepartment of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
David QianDepartment of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
David JaffrayDepartment of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Caroline ChungInstitute of Data Science in Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Natalie I VokesDepartment of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.ORCID http://orcid.org/0000-0002-3766-5335
Jianjun ZhangDepartment of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.ORCID http://orcid.org/0000-0001-7872-3477
J Jack LeeDepartment of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.ORCID http://orcid.org/0000-0001-5469-9214
John V HeymachDepartment of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Jia WuDepartment of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA jychang@mdanderson.org JWu11@mdanderson.org.ORCID http://orcid.org/0000-0001-8392-8338
Joe Y ChangDepartment of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA jychang@mdanderson.org JWu11@mdanderson.org.ORCID http://orcid.org/0000-0002-8435-2083

Funding

Tumor Evolution and Metastasis ProgramP30CA016672 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI DIANE BODURKA · 1985 to 2026
$290.8M
U OF TEXAS HLTH SCI CTR HOUSTON CENTER FOR CLINICAL AND TRANSLATIONAL SCIENCESUL1RR024148 · NCRR · UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON · PI MCPHERSON, DAVID D · 2006 to 2010
$27.9M
NCI NIH HHS P30 CA016672NCRR NIH HHS UL1 RR024148
6 · The paper itself

Abstract

backgroundThe recent phase II randomized stereotactic ablative radiotherapy with and without immunotherapy (I-SABR) trial has shown improved event-free survival (EFS) when adding immunotherapy to stereotactic ablative radiotherapy (SABR) for early-stage inoperable non-small cell lung cancer (NSCLC). However, optimizing patient selection thereof is critical, because not every patient benefits from immunotherapy. Leveraging the powerful use of artificial intelligence, this secondary analysis of the I-SABR trial developed a modeling system (named "I-SABR-SELECT") based on clinical and radiomic factors to address which patients should receive additional immunotherapy.

methodsThe discovery/validation cohorts were from the I-SABR trial, with external validation from the single-arm STARS trial. Individual treatment effect scores, estimating the benefit of adding immunotherapy, were derived from radiomic and clinical predictors using counterfactual reasoning. Dimensionality reduction was applied to mitigate overfitting and enhance model robustness. We also evaluated the average treatment effect between subgroups of patients who were treated following versus against the model's recommendation.

resultsThe model recommended that 49% (69/141) patients enrolled in the I-SABR trial switch treatments (65% (49/75) in the SABR arm and 30% (20/66) in the I-SABR arm). Patients treated by the model's recommendation had higher EFS, with HRs of 0.06 (in the I-SABR arm, p<0.001) and 0.26 (in the SABR alone arm, p=0.0042) from the I-SABR trial population, and 0.38 (p=0.031) for the STARS trial. Following model stratification, among patients recommended for SABR+immunotherapy, the restricted mean survival time for EFS is prolonged by 1.43 years compared to those who received SABR alone. The absolute risk reduction of the added immunotherapy effect was over twofold greater than that observed in the I-SABR trial without selection.

conclusionsCombining clinical and radiomic parameters, I-SABR-SELECT uses causal reasoning to individualize treatment selection for patients with early-stage inoperable NSCLC. If validated, it could serve as a foundation for a treatment-focused digital twin by integrating real-time adaptive decision-making.

Indexed as

Artificial IntelligenceCarcinoma, Non-Small-Cell LungImmunotherapyLung NeoplasmsPatient SelectionRadiosurgeryAgedCombined Modality TherapyFemaleHumansMaleMiddle AgedNeoplasm StagingRadiomicsBiomarkerLung CancerRadiotherapy/radioimmunotherapyStatisticsSurvivorship

Identifiers

PMID41052882
PMCPMC12506444

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.