What question did this study set out to answer?

This study aims to evaluate the outcomes and toxicity of consolidative thoracic radiotherapy in patients with NSCLC previously treated with immune checkpoint inhibitors.

March 21, 2026Open Access

93P Immunotherapy in advanced/metastatic lung cancer: A real-world study of long-term survivors

Key Points

This study aims to evaluate the outcomes and toxicity of consolidative thoracic radiotherapy in patients with NSCLC previously treated with immune checkpoint inhibitors.
Conducted a retrospective analysis at a single institution.
Included NSCLC patients who received consolidative thoracic radiotherapy after prior immune checkpoint inhibitors.
Primary endpoints measured were local failure-free survival, progression-free survival, and overall survival.
1-year local failure-free survival was 87.1%; 3-year was 66.4%.
Median progression-free survival was 19.6 months.
Median overall survival was 48.8 months.
Acute Grade 2 radiation pneumonitis occurred in 27.9% of patients, linked to the duration of prior ICI treatment.

Abstract

Background: Consolidative thoracic radiotherapy (CTRT) improves outcomes in advanced non-small cell lung cancer (NSCLC) after chemotherapy (CT).However, the efficacy and safety of high-dose CTRT following immune checkpoint inhibitors (ICIs) are not fully characterized.This study evaluates CTRT outcomes and toxicity in NSCLC patients previously treated with (CT-)ICIs.Methods: A retrospective single-institution analysis was conducted on patients receiving CTRT after first-line (CT-)ICIs.Primary endpoints were local failure-free survival (LFFS), progression-free survival (PFS), and overall survival (OS) using the Kaplan-Meier method.Toxicities were graded via Common Terminology Criteria for Adverse Events (CTCAE).Results: 43 patients with NSCLC treated between 2019 and 2024 were included.At presentation, 48.8% had locally advanced disease unsuitable for definitive chemoradiotherapy, while 51.2% were metastatic.Most (88.4%) received PD-1 inhibitors (median 6 cycles, range 1-31).CTRT median equivalent dose in 2 Gy fractions was 50.0 Gy, with 51.2% receiving radical doses (median 59.2 Gy) and 48.8% subradical doses (median 48.8 Gy).At a median follow-up of 35.7 months (95% CI: 28.9-45.3):-Survival: 1-year and 3-year LFFS were 87.1% and 66.4%.Median PFS was 19.6 months (95% CI: 9.8-NE); median OS was 48.8 months (95% CI: 15.5-NE).-Toxicity: Grade 2 radiation pneumonitis (RP) incidence was 27.9% (occurring at a median of 2.3 months post-CTRT).Grade 3 and Grade 5 RP occurred in 11.6% and 2.3%, respectively.-Correlations: Acute Grade 2 RP was significantly associated with prior ICI duration (9.5% for 6 cycles vs. 40.0%for 7 cycles; p= .03).Prescribed CTRT dose did not significantly impact RP rates (27.3% radical vs 28.6% subradical, p= .92).-Overall Pulmonary Events: Grade 2, grade 3 and grade 5 pulmonary event rates (all etiologies) were 32.6%, 18.6% and 7.0%, respectively. Conclusions:For advanced NSCLC responding to first-line ICIs, high-dose CTRT provides encouraging oncological control with manageable toxicity.Notably, prolonged ICI administration prior to CTRT significantly increases the risk of acute RP.

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