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@ARTICLE{Taugner:305607,
author = {J. Taugner and S. Stamer and K. Hofstetter and C. Eze$^*$
and L. Käsmann$^*$ and K. Clasen and P. Hartig and W.
Spengler and T. Groß and F. Manapov and C. Belka$^*$ and M.
Niyazi$^*$},
title = {{I}mmune checkpoint inhibition alters patterns of failure
in inoperable stage {III} non-small cell lung cancer
patients treated with chemoradiotherapy.},
journal = {Journal of cancer research and clinical oncology},
volume = {151},
number = {12},
issn = {0301-1585},
address = {Heidelberg},
publisher = {Springer},
reportid = {DKFZ-2025-02257},
pages = {313},
year = {2025},
abstract = {We compared failure patterns in patients with inoperable
stage III non-small cell lung cancer (NSCLC) treated with
chemoradiotherapy (CRT) alone versus CRT combined with
sequential and/or concurrent immune checkpoint inhibitors
(CRT-IO).Retrospective real-world data from 221 patients
across two German tertiary cancer centers were analyzed. Of
these, 74 received CRT-IO, including sequential durvalumab
$(85\%)$ and concurrent/sequential nivolumab $(15\%),$ while
148 received CRT alone. First failure site and time to
failure were compared.Between 2012 and 2022, all patients
received thoracic radiotherapy (≥ 60 Gy) and at least two
cycles of platinum-based chemotherapy. Induction
chemotherapy was administered in $36\%,$ and induction
chemo-immunotherapy in $2\%.$ Median follow-up was 51.7
months $(95\%$ CI 47.0-56.4). Median overall survival (OS)
for the entire cohort was 37.1 months $(95\%$ CI 26.0-48.2),
with OS in the CRT-IO group not reached vs. 27.1 months
$(95\%$ CI 18.5-25.7) in the CRT group (p < 0.001). Median
progression-free survival (PFS) was 22.8 months $(95\%$ CI
6.4-39.1) for CRT-IO versus. 9.9 months $(95\%$ CI 7.0-12.8)
for CRT (p = 0.001, see Fig. 1). Failure patterns differed
significantly. CRT-IO patients had lower loco-regional
progression (LRP) rates $(9.5\%$ vs. $21.8\%,$ p = 0.023)
and were more frequently alive without progression $(45.9\%$
vs. $16.3\%,$ p < 0.001). Brain metastasis (BM) as the first
failure, multifocal progression (MFP) and isolated
extracranial distant metastasis (ecDM) rates were comparable
between the CRT and CRT-IO subgroup. Women had a higher risk
of isolated BM $(17.3\%$ vs. $6.8\%,$ p = 0.016), whereas
squamous cell carcinoma (SCC) patients had higher LRP rates
$(25.3\%$ vs. $13.0\%,$ p = 0.016). Median post-progression
survival (PPS) was 19.4 months $(95\%$ CI 16.8-22.0) for
CRT-IO and 9.5 months $(95\%$ CI 5.8-13.1) for CRT (p =
0.207). PPS was longer after BM (19.9 months) vs. LRP (8.5
months, p = 0.076) and significantly better in women (20.7
vs. 8.9 months, p = 0.012) and
adenocarcinoma/non-otherwise-specified-carcinoma (AC/NOS)
vs. SCC (p < 0.001).CRT-IO significantly improves OS, PFS,
and LRP control compared to CRT alone. Failure patterns and
survival disparities by histology and gender suggest
tailored surveillance and treatment strategies are needed.
Further studies should optimize management of LRP and
long-term outcomes in CRT-IO-treated patients.},
keywords = {Humans / Carcinoma, Non-Small-Cell Lung: therapy /
Carcinoma, Non-Small-Cell Lung: pathology / Carcinoma,
Non-Small-Cell Lung: drug therapy / Carcinoma,
Non-Small-Cell Lung: mortality / Carcinoma, Non-Small-Cell
Lung: immunology / Female / Male / Immune Checkpoint
Inhibitors: therapeutic use / Immune Checkpoint Inhibitors:
administration $\&$ dosage / Lung Neoplasms: pathology /
Lung Neoplasms: therapy / Lung Neoplasms: drug therapy /
Lung Neoplasms: mortality / Lung Neoplasms: immunology /
Aged / Middle Aged / Retrospective Studies /
Chemoradiotherapy: methods / Neoplasm Staging / Adult /
Aged, 80 and over / Treatment Failure / Nivolumab:
administration $\&$ dosage / Antineoplastic Combined
Chemotherapy Protocols: therapeutic use / Antibodies,
Monoclonal / Chemoradiotherapy (Other) / Immunotherapy
(Other) / Lung cancer (Other) / NSCLC (Other) /
Patterns-of-failure (Other) / Immune Checkpoint Inhibitors
(NLM Chemicals) / Nivolumab (NLM Chemicals) / durvalumab
(NLM Chemicals) / Antibodies, Monoclonal (NLM Chemicals)},
cin = {MU01},
ddc = {610},
cid = {I:(DE-He78)MU01-20160331},
pnm = {899 - ohne Topic (POF4-899)},
pid = {G:(DE-HGF)POF4-899},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:41175229},
doi = {10.1007/s00432-025-06355-y},
url = {https://inrepo02.dkfz.de/record/305607},
}