Immunotherapy With Stereotactic Body Radiation Therapy in Early-Stage Non‑Small Cell Lung Cancer: Matching Risk, Biology, and Timing
Mené sur 448 patients atteints d'un cancer du poumon non à petites cellules de stade I ou II inopérable ou après refus d'une chirurgie, cet essai randomisé de phase III évalue l'efficacité, du point de vue de la survie sans événement, et la toxicité de l'ajout de pembrolizumab à une radiothérapie stéréotaxique corporelle (traitement standard)
Of the approximately 190,000 people diagnosed with non‑small cell lung cancer (NSCLC) each year in the United States, half will present with nonmetastatic disease for which treatments can lead to cure. Management of such patients can incorporate multiple modalities of treatment, including radiation or surgery, sometimes with preoperative or postoperative chemotherapy and immunotherapy. For patients with stage I to II, node-negative disease who are deemed medically inoperable or have declined surgery, stereotactic body radiation therapy (SBRT) provides a curative therapy option. To improve the overall effectiveness of SBRT and address recurrence outside of the radiation field, investigators have sought to add systemic therapy. We know that delivery of an immune checkpoint inhibitor after completion of chemoradiation therapy can significantly improve overall survival, while giving the same checkpoint inhibitor concurrently with chemoradiation was not associated with benefit.1,2 At the same time, in patients with advanced disease, it has become clearer that patients with very high PD-L1 levels derive the greatest benefit from single-agent checkpoint inhibitors and patients with some oncogenic drivers rarely derive benefit. These data suggest that immune checkpoint inhibitors improve outcomes only when the timing, disease setting, and patient biology align with a meaningful probability of benefit.
Journal of Clinical Oncology , éditorial en libre accès, 2026