# Efficacy of immunotherapy remained in patients with recurrent/metastatic non‐small‐cell lung cancer after surgery with or without postoperative thoracic radiotherapy: a bi‐center retrospective study

## TL;DR

This study found that immunotherapy remains effective in lung cancer patients who previously had surgery with or without radiation therapy.

## Contribution

The novel contribution is showing that prior thoracic radiotherapy does not reduce immunotherapy effectiveness in recurrent/metastatic NSCLC patients.

## Key findings

- Patients who received thoracic RT had comparable progression-free survival to those who did not.
- Immunotherapy toxicity rates were similar between RT and non-RT groups.
- ICIs remained effective regardless of prior RT in advanced NSCLC patients.

## Abstract

Since mediastinal lymph node dissection and radiotherapy (RT) have potential unclear impacts on pulmonary lymphatic system, this study aimed to assess the effectiveness of immune checkpoint inhibitors (ICIs) in recurrent/metastatic non‐small‐cell lung cancer (NSCLC) patients who previously received radical surgery with or without thoracic RT.

Clinical data of patients who underwent pulmonary lobectomy with systematic lymphadenectomy (2000.1.1–2021.7.2) and received immunotherapy after progression were retrospectively analyzed. Efficacy was mainly evaluated based on progression‐free survival (PFS) from the start of the ICIs. Toxicity was defined as treatment discontinuation due to immune‐related adverse effects (irAEs).

Ninety‐five patients were enrolled in the final cohort and 30 (31.6%) patients received thoracic RT before ICI treatment. ICIs were administered as a first‐line systematic treatment in 52.6% of patients. The median follow‐up time was 14.7 months (95% confidence interval [CI] 13.3–18.7 months). The median PFS was 12.3 months (95% CI 8.5–36.6 months). Six (6.3%) patients had treatment suspended due to irAEs. Patients who received RT had comparable median PFS with the non‐RT group (17.0 months vs. 11.1 months, p = 0.16). Similar toxicity rates were observed. Similar mPFS were reported in the stage III subgroup (RT vs. non‐RT, 8.10 vs. 8.45 months, p = 0.86) or the subgroup treated by ICIs as primary systematic therapy (RT vs. non‐RT, 13.6 vs. 16.1 months, p = 0.45).

ICIs remained effective in recurrent/metastatic NSCLC patients with radical surgery and RT did not significantly compromise therapeutic effects.

At some point after undergoing radical surgery for lung cancer with or without thoracic radiation therapy afterwards, the patient experienced disease progression. Response was observed after receiving immunotherapy.