Study points to promising chemoimmunotherapy strategy for aggressive stage III non-small cell lung cancer

A study led by Dana-Farber Cancer Institute researchers found that combining chemotherapy and immunotherapy before surgery for patients with aggressive stage III non-small cell lung cancer that is considered difficult or impossible to surgically remove can help shrink tumors and make surgery possible.

Published in JAMA Oncology, the multicenter observational study was conducted in collaboration with Memorial Sloan Kettering Cancer Center and IRCCS Regina Elena National Cancer Institute in Rome, Italy. It analyzed data from 112 patients who were treated at cancer centers across the U.S. and Italy with chemoimmunotherapy—a combination of chemotherapy and an immune checkpoint inhibitor blocking PD-1 or PD-L1.

After treatment, 75% of patients were able to undergo surgery. Of those patients, 1 in 3 achieved complete tumor clearance. The treatment also significantly extended the time patients lived without cancer progression, particularly in patients who experienced complete tumor clearance. Patients with high levels of PD-L1 in their tumors were more likely to have a pathologic complete response and prolonged event-free survival. Patients with mutations in KRAS and STK11 or KRAS and KEAP1 did not benefit from this approach.

Patients with borderline resectable or unresectable stage III non-small cell lung cancer have limited treatment options. The findings support a new possibility to offer neoadjuvant chemo-immunotherapy as a potential treatment strategy for carefully selected patients in this group. Prospective, randomized trials are necessary to confirm these findings and define which patients benefit most.