WCLC 2025 - Posters & ePosters-P2.08 .51 Outcomes From a Phase II Study of Hypofractionated Chemoradiation and Consolidation Immunotherapy in Locally-Advanced NSCLC

Pdf Summary

This Phase II single-arm, prospective study evaluated hypofractionated chemoradiation with consolidation immunotherapy in 26 patients with locally advanced non-small cell lung cancer (LA-NSCLC). Eligible patients with stage IIB to select IIIC disease received 60 Gy radiation in 15 fractions using magnetic resonance-guided radiation therapy (MRgRT) with intermittent online adaptive treatments at fractions 6, 9, and 12, combined with weekly carboplatin/paclitaxel chemotherapy. Consolidation durvalumab immunotherapy followed chemoradiation.<br /><br />The primary endpoint was locoregional control (LRC), with secondary outcomes including overall survival (OS), progression-free survival (PFS), distant metastasis rate, and toxicity. Median follow-up was 23 months overall and 32.5 months for living patients. The study reported an LRC of 76.9%, distant control of 61.5%, and brain metastasis rate of 15.4%. Median OS was 25.7 months, and median PFS was 8.8 months. All local failures were isolated, whereas regional failures occurred only with concurrent distant metastases.<br /><br />Treatment completion was high for chemoradiation (100% radiation, 96% chemotherapy), but durvalumab consolidation completion was lower (23%), largely due to progression or toxicity. Acute toxicities included grade 2 esophagitis (10 patients), with few grade 3 events and no grade 4–5 toxicities. Two deaths possibly related to treatment occurred shortly after chemoradiation (respiratory failure, hemoptysis). Intermittent adaptive radiotherapy showed minimal dosimetric improvements for organs at risk with no clear toxicity benefit.<br /><br />The study concludes that hypofractionated chemoradiation with consolidation immunotherapy is feasible and provides excellent locoregional control, with safety and efficacy comparable to conventional radiation regimens. The lack of significant benefit from intermittent adaptive planning suggests non-adaptive photon-based hypofractionation may safely substitute for conventional treatment. Further prospective trials are recommended to confirm these findings.<br /><br />This approach may offer a shorter, effective treatment option for LA-NSCLC patients, addressing prior limitations of hypofractionation related to toxicity, while supporting durable disease control.

Asset Subtitle

Gregory Vlacich

Meta Tag

Speaker Gregory Vlacich

Topic Local-Regional Non-small Cell Lung Cancer

Keywords

hypofractionated chemoradiation

consolidation immunotherapy

locally advanced non-small cell lung cancer

magnetic resonance-guided radiation therapy

intermittent online adaptive treatments

carboplatin/paclitaxel chemotherapy

durvalumab

locoregional control

overall survival

treatment toxicity