Evaluating Immunotherapy as Systemic Therapy Plus RT in Early-Stage NSCLC

Immunotherapy in early-stage non-small cell lung cancer (NSCLC) has gained interest as a method to improve outcomes for this patient population, according to Patrick Oh, MD.

CancerNetwork® spoke with Oh, a hospital resident at the Yale School of Medicine, about the rationale for assessing trends of real-world use of immunotherapy, chemotherapy, and targeted therapy in patients with early-stage node-negative NSCLC undergoing radiotherapy as curative treatment. He discussed the background in context of a study he presented at the 2024 American Society of Radiation Oncology (ASTRO) Annual Meeting.

Oh began by outlining the National Comprehensive Cancer Network (NCCN) guidelines, which state that curative surgery or radiotherapy are the standard of care (SOC) for early-stage node-negative NSCLC. He then highlighted patient eligibility for treatment, indicating that patients with competing risks are likely selected for radiotherapy. Oh highlighted favorable outcomes with radiotherapy but stated that distant recurrence may be possible in the years following treatment.

In light of surgery and radiotherapy as SOC treatment in this patient population, Oh stated that novel therapeutics are still being evaluated to improve patient outcomes, with immunotherapy of particular interest. In his study, he and his team investigated radiotherapy use trends to assess if systemic immunotherapy use was increasing in practice.

In the study, the patient population for analysis was selected from the nationwide Flatiron Health electronic health record (HER)-derived database. Patients with early-stage node-negative NSCLC between 2019 and 2023 were selected if they had undergone definitive radiotherapy with or without frontline systemic therapy.

A larger proportion of patients with squamous cell carcinoma (no systemic therapy, 38%; systemic therapy, 50%; P < .001) and PD-L1–positive expression of 1% to 49% (47%, 53%; P = .042) received systemic therapy. Additionally, no ALK-rearranged cases were observed in the total analysis set, and 27 of 1,439 patients who had not received systemic therapy had EGFR mutations, as well as 13 of 260 who had received systemic therapy (P = 0.10).

Transcript:

Current NCCN guidelines suggest that standard-of-care practice for patients with early-stage node-negative disease of non–small cell lung cancer are candidates to undergo surgery or radiation therapy for curative treatments. Typically, patients are first evaluated by a surgeon to see if they can proceed to the operating room [OR], but if they have competing risks, such as comorbidities, then they would be a candidate for radiation therapy. The outcomes have been very good as reporting literature for patients who [receive] radiation therapy as curative treatment, but they still remain at risk for distant recurrence, and that can be up to 20% in 5 years.

As a field, we have had an interest in finding novel therapeutic methods to improve outcomes for these patients, and something that has picked up a lot of interest is the use of immunotherapy in the early-stage setting. We sought to investigate the use of that in current practice right now, off trial [while] essentially abiding by NCCN guidelines to see if the use of systemic therapy is becoming more widespread.

Reference

Oh P, Sasse A, Wells N, Kim SY, Goldberg SB, Park HS. Real-world practice patterns of immunotherapy, chemotherapy, and targeted therapy with radiation therapy in early-stage node-negative non-small cell lung cancer. Int J Radiat Oncol. 2024;120(suppl 2):e52-e53. doi:10.1016/j.ijrobp.2024.07.1893