Timing Is of the Essence: Sequencing Immune Checkpoint Blockade and Radiotherapy for Success in Lung Cancer
Mené sur 506 patients atteints d'un cancer du poumon à petites cellules de stade limité, cet essai international de phase III évalue l'efficacité, du point de vue de la survie globale, d'un ajout d’atézolizumab à une chimioradiothérapie
Combining immunotherapy with chemoradiotherapy (CRT) to improve patient outcomes in solid tumors has proven to be challenging. Five randomized phase III trials in thoracic oncology, including two in limited-stage small cell lung cancer (LS-SCLC), have been presented in the past 2 years, with mixed results. While the ADRIATIC trial1 demonstrated a nearly 3-year improvement in median overall survival (OS) with the use of consolidative durvalumab after CRT in LS-SCLC, NRG/Alliance LU005 showed no improvement in outcomes with the use of concurrent and consolidative atezolizumab. These striking differences mirror those seen in trials of locally advanced unresectable non–small cell lung cancer (NSCLC)—while the 5-year update of the PACIFIC trial2 reported an approximately 18-month improvement in OS with the use of consolidative durvalumab after CRT, the recently published PACIFIC-2 trial3 found no improvement in outcomes with the use of concurrent and consolidative immunotherapy. These results, demonstrating a consistent lack of benefit to concurrent immunotherapy and radiotherapy (RT), add to the growing body of evidence, suggesting that the timing of immunotherapy initiation in relation to RT, rather than the combination of modalities per se, may be critical to optimizing treatment going forward.
Journal of Clinical Oncology , éditorial en libre accès, 2026