Systemic effect of radiotherapy before or after nivolumab in lung cancer: an observational, retrospective, multicenter study

Author:

Bassanelli Maria1ORCID,Ricciuti Biagio2,Giannarelli Diana3,Cecere Fabiana Letizia4,Roberto Michela5,Giacinti Silvana6,Barucca Viola7,Santarelli Mario8,Ruggeri Enzo Maria9,Marchetti Paolo5,Cognetti Francesco1011,Gelibter Alain12,Cortesi Enrico12,Chiari Rita13,Milella Michele14,Ceribelli Anna1

Affiliation:

1. Department of Oncology, San Camillo de Lellis Hospital, Rieti, Italy

2. Department of Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy

3. Biostatistic Unit, IRCSS Regina Elena National Cancer Institute, Rome, Italy

4. Division of Medical Oncology 1, IRCSS Regina Elena National Cancer Institute, Rome, Italy

5. Department of Oncology, University of Rome "Sapienza," Rome, Italy

6. Department of Oncology, Belcolle Hospital–Viterbo, Viterbo, Italy

7. Department of Oncology, Misericordia Hospital, Grosseto, Italy

8. Department of Radiotherapy, San Camillo de Lellis Hospital, Rieti, Lazio, Italy

9. Department of Oncology, Belcolle Hospital–AUSL–Viterbo, Viterbo, Italy

10. Division of Medical Oncology 1, Regina Elena National Cancer Institute, Rome, Italy

11. Department of Clinical and Molecular Medicine, La Sapienza University, Rome, Italy

12. Medical Oncology Unit, Policlinico Umberto I, Rome, Italy

13. Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy

14. Division of Oncology, Integrated University Hospital of Verona, Verona, Italy

Abstract

Background: The combination of radiotherapy (RT) and programmed death 1 inhibitors seems to increase antitumor immune responses. Objective: To assess the outcome and the role of the best combination sequence, i.e. immunotherapy given before, during, and/or after RT, in patients with non-small cell lung cancer (NSCLC). Methods: We conducted an observational, retrospective analysis of 95 consecutive patients with advanced NSCLC who received any radiotherapy treatment and nivolumab, as clinically indicated. Median overall survival (OS) and the 95% confidence interval (CI) were estimated with the Kaplan-Meier method. Cox model was used to obtain hazard ratio (HR) and associated 95% CI with statistical inference by log-rank statistic. Results: Median OS was 11.9 months (95% CI, 6.6–17.2). Patients who received radiotherapy during an immune checkpoint inhibitor treatment started more than 60 days before showed a better outcome than patients who started immunotherapy over 60 days after RT ending (HR, 2.90 [1.37–6.12], p = 0.005; median OS, 22.4 months vs 8.6 months, p = 0.005). Median progression-free survival was 6.3 months (95% CI, 4.6–8.0). Conclusions: This study shows that combining irradiation with nivolumab for the treatment of advanced NSCLC leads to improved OS. The optimal time window for the combination of RT and immunotherapy seems to play a critical role for therapeutic antitumor response derived by abscopal effect.

Publisher

SAGE Publications

Subject

Cancer Research,Oncology,General Medicine

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