Real-world outcomes of stage III NSCLCs managed by surgery or definitive radiation therapy in the era of immunotherapy

OBJECTIVES: Immunotherapy (IO) has been associated with better outcomes in locally advanced non-small cell lung cancers (NSCLCs). In 2017, our center introduced compassionate use of immunotherapy for stage III NSCLC as follows: neoadjuvant chemotherapy combined to perioperative immunotherapy and surgery for resectable NSCLCs (PERIOPERATIVE) and chemo-radiation therapy followed by immunotherapy (PACIFIC) for non-resectable NSCLCs. We report the outcomes and complications of 78 patients. METHODS: IWe reviewed all stage III NSCLC patients treated in the Center or Thoracic Surgery of Romandie (CURCT) between 2017 and 2023 with chemo-immunotherapy and surgery and radiation therapy using our prospectively collected database. We compared groups using Stata®. RESULTS: Intention to treat population consisted in 52 PERIOPERATIVE and 26 PACIFIC patients. PERIOPERATIVE patients were significantly younger (64 [60-71]vs73 [67-80], p = 0.0001) and had better lung diffusion capacity compared to PACIFIC patients (%predicted DLCO: 74 ± 18vs48 ± 26, p = 0.0008). Complications over the course of therapy occurred in more than 50 % of patients but remained manageable in both groups. Forty-two of 52 PERIOPERATIVE (81 %) and 18 of 26 (69 %) PACIFIC patients completed the entire treatment plan. There was no 30-day mortality. Complete pathological response (pCR) occurred in 11 of the 50 operated PERIOPERATIVE patients (22 %) and was associated with a 100 % 5-year survival. Overall, 5-year survival was of 78 % and 30 % in the PERIOPERATIVE and PACIFIC groups respectively. CONCLUSION: The inclusion of immunotherapy in the management of stage III NSCLC has been associated with improved patient outcomes. Real life data suggests that patient complications are frequent but manageable and that patient dropout is low.