In a Chinese cohort study (OCEANUS) reported in JAMA Oncology, Zhou et al found that sequential radiotherapy (RT) and immune checkpoint inhibitor (ICI) therapy was associated with better overall survival vs concurrent RT and ICI therapy in patients with advanced newly diagnosed or refractory non–small cell lung cancer (NSCLC).
Study Details
The territory-wide study included data from patients in the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System (more than 90% population coverage) diagnosed between January 2010 and December 2021 who subsequently received RT and ICI treatment for advanced or refractory disease. The primary outcome measure was overall survival.
Key Findings
Among a total of 3,522 patients who received ICIs, 335 received RT, including 155 with newly diagnosed advanced disease (of whom 80 also received chemotherapy) and 180 with refractory disease (of whom 44 also received chemotherapy).
For patients with newly diagnosed advanced disease, median overall survival was 20.3 months (95% confidence interval [CI] = 13.3 months to not reached) among those treated with sequential RT and then maintenance ICI therapy vs 16.0 months (95% CI = 8.3–30.0 months) among those receiving concurrent RT and ICI therapy (adjusted hazard ratio [HR] = 0.68, 95% CI = 0.47–0.99, P = .045). Among patients who received chemotherapy, sequential treatment was associated with a significant improvement (P = .03) in restricted mean survival time (RMST) at 36 months (RMST analysis performed due to violation of proportional hazards assumption). Among those who did not receive chemotherapy, no significant advantage of sequential vs concurrent therapy was observed (adjusted HR = 0.69, 95% CI = 0.40–1.19, P = .18).
Among patients with refractory NSCLC, median overall survival was 11.2 months (95% CI = 7.9–20.6 months) with sequential treatment vs 6.7 months (95% CI = 4.4–17.4 months) with concurrent treatment (adjusted HR = 0.72, 95% CI = 0.44–1.18, P = .20). Receipt of chemotherapy was not associated with benefit in the sequential treatment group (adjusted HR = 1.11, 95% CI = 0.49–2.49, P = .80).
The investigators concluded: “In this cohort study, sequential [RT and immunotherapy] was associated with longer survival than concurrent [RT and immunotherapy] in patients with newly diagnosed advanced NSCLC, and chemotherapy was associated with longer survival. In patients with refractory NSCLC who survived at least 90 days, RT with ICI maintenance resulted in nonsignificantly longer survival and an unclear association with chemotherapy. These findings are hypothesis-generating and support prospective randomized studies to define optimal sequencing of [RT and immunotherapy] and use of systemic treatment partners.”
Feng-Ming (Spring) Kong, MD, PhD, of the Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, is the corresponding author for the JAMA Oncology article.
DISCLOSURE: The study was supported by the National Natural Science Foundation of China, Shenzhen Medical Research Fund, and others. For full disclosures of the study authors, visit jamanetwork.com.
