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

Abstract

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). This study retrospectively compared the efficacy and safety of first-line treatments for unresectable stage III NSCLC. Methods:We retrospectively analyzed 397 patients for unresectable stage III NSCLC. Adverse events and responses were assessed using CTCAE v5.0 and RECIST v1.1. Results: In negative driver genes group, the radiotherapy group had longer objective response rate (ORR), disease control rate (DCR)and median progression-free survival (mPFS) than 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), with increased incidence of pneumonia at any grade (P=0.008). In radiotherapy group, the chemoradiotherapy (CRT) plus immunotherapy subgroup had longer mPFS than the CRT subgroup (24.60 vs. 17.90 months, P=0.025), with increased toxicity at any grade (P=0.035). In non-radiotherapy group, the DCR and mPFS were higher in chemoimmunotherapy subgroup versus chemotherapy subgroup (DCR: P＜0.001; mPFS: P＜0.001), with increased toxicity at any grade (P=0.001). In positive driver genes group, the efficacy did not differ among radiotherapy subgroup, targeted therapy subgroup and radiotherapy plus targeted therapy subgroup (ORR: P=0.633; mPFS: P=0.450). Conclusions: For patients with negative driver genes, the combination of radiotherapy and immunotherapy in the initial treatment were essential to significantly improve the efficacy. For patients with positive driver genes, radiotherapy and targeted therapy showed similar short-term efficacy.