Real-World Outcomes of Induction Chemotherapy With or Without Low-Dose Nivolumab for Stage III Non-Small Cell Lung Cancer Ineligible for Up-Front Local Therapy: A Propensity Score-Matched Analysis

Abstract

Purpose: There is a lack of literature on treating stage III non-oncogene-driven non-small cell lung cancer (NSCLC) with low-dose immunotherapy in combination with chemotherapy for patients who are not candidates for local therapy up front.

Materials and methods: We performed an institutional retrospective analysis of patients with stage III non-oncogene-driven NSCLC deemed ineligible for up-front local therapy. The NACT + I/O group comprised those who received induction chemotherapy in combination with low-dose nivolumab, and the NACT-alone group comprised those who received chemotherapy alone. Propensity score matching was performed based on stage, histology, and respiratory comorbid status. The primary end point was objective response rate (ORR). Secondary end points were conversion rates to local therapy, progression-free survival (PFS), overall survival (OS), and Grade ≥3 adverse events.

Results: Eighty-two patients were equally divided into the NACT + I/O and NACT-alone groups. The most common histology was squamous cell (60%), followed by adenocarcinoma (34%) and mixed (5%). Majority (85%) had stage IIIB or IIIC disease. The ORR to induction was 73.1% (complete response 1, partial response [PR] 29, stable disease [SD] 10, progressive disease [PD] 1) in the NACT + I/O group versus 39% (PR-16, SD-13, PD-12) in the NACT-alone group (P = .002). The NACT + I/O group had a higher proportion of patients undergoing sequential local therapy (66% v 46.3%, P = .075), a better median PFS (not reached [NR] v 11 months, P = .0014), and median OS (NR v 28 months, P = .22) compared with the NACT-alone group at a median follow-up of 13.5 months. There were no new safety signals identified.

Conclusion: Adding low-dose immunotherapy to chemotherapy improved ORRs, conversion rates to local therapy, and PFS in patients with stage III non-oncogene-driven NSCLC, who were ineligible for up-front local therapy.