Prior curative-intent treatment strategy affects progression outcomes of first-line immunotherapy in metastatic non-small cell lung cancer: A retrospective cohort study.

Abstract

Non-small cell lung cancer (NSCLC) represents the most prevalent histological subtype of lung malignancies, accounting for the vast majority of new diagnoses and remaining a leading cause of oncology-related mortality worldwide. Despite recent therapeutic advancements, the disease maintains a formidable clinical burden, with global incidence rates continuing to rise. Consequently, optimizing treatment sequencing and identifying predictive factors for therapy response remain critical priorities in improving long-term patient outcomes. The present study aimed to evaluate the impact of prior curative-intent treatment strategy on disease progression outcomes during first-line immunotherapy in patients with metastatic NSCLC. The present retrospective, single-center cohort study included 62 patients with advanced NSCLC who developed metastatic disease after receiving curative-intent treatment. Before metastasis, patients had been administered with either adjuvant chemotherapy or definitive chemoradiotherapy. All patients subsequently received first-line immunotherapy after developing metastatic disease. The primary endpoint was disease progression status (presence or absence) during a 24-month follow-up period. Progression-free survival (PFS) was evaluated among patients with disease progression. Results showed that during the 24-month follow-up, disease progression occurred in 33 patients (53.2%). Although not statistically significant, progression was observed more frequently in patients previously treated with adjuvant chemotherapy compared with those who had received definitive chemoradiotherapy (68.0 vs. 43.2%; P=0.055). Among the patients who developed progression, the median PFS was 7.98 months for those in the adjuvant chemotherapy group and 9.82 months for those in the definitive chemoradiotherapy group, with no statistically significant difference observed between the groups. First-line immunotherapy-related adverse events occurred at comparable rates in both groups, with the most frequent toxicities being thyroid dysfunction, pulmonary toxicity and neuropathy. In summary, compared with prior adjuvant chemotherapy, prior definitive chemoradiotherapy demonstrated a potential trend toward a lower risk of disease progression during first-line immunotherapy for metastatic NSCLC, without an associated increase in treatment-related toxicity, such as immune-related adverse events. These findings suggested that previous curative-intent treatment strategies may influence progression outcomes during subsequent immunotherapy.