Purpose: The purpose of this study was to investigate the prognostic differences between patients with small-cell lung cancer (SCLC) with different chemosensitivity to first-line chemotherapy who developed brain metastasis (BM) as the first site of progression. Methods: Patients with a BM after first-line treatment in the Tianjin Cancer Hospital were retrospectively analyzed. According to the time-free interval (TFI) between the completion of first-line chemotherapy and the onset of the BM, the patients were divided into the chemo-sensitive group (TFI ≥ 90 days, n = 145) and the chemo-resistant group (TFI < 90 days, n = 97). The survival time, which was calculated from the diagnosis of the BM, was analyzed after the onset of brain metastasis (BM-OS). Survival curves were plotted using the Kaplan–Meier method, and differences between groups were compared using the log-rank test. Results: In total, the median BM-OS was 8.4 months. The median BM-OS in the chemo-sensitive group was 8.8 months, and it was 8.0 months in the chemo-resistant group (p = 0.538). In patients without extracranial progression (n = 193), the median BM-OSes in the chemo-sensitive and chemo-resistant groups were 9.4 months and 9.7 months, respectively (p = 0.947). In patients with extracranial progression (n = 49), the median BM-OSes in the chemo-sensitive and chemo-resistant groups were 5.4 months and 4.2 months, respectively (p = 0.161). Conclusion: After the development of a BM as the first site of progression following chemotherapy in patients with SCLC, the prognosis of chemo-sensitive patients was not necessarily superior to chemo-resistant patients, especially in patients without extracranial progression.

Aim: To assess the efficacy and safety of EGFR inhibitors combined with (chemo)radiotherapy in unresectable, locally advanced non-small-cell lung cancer. Materials & methods: A systematic review and meta-analysis of prospective trials was performed. Results: Twenty-eight studies of 1640 patients were included. In patients harboring EGFR-sensitive mutations, the pooled objective response rate, 1-year overall survival rate and 1-year progression-free survival rate of EGFR-TKIs + (chemo)radiotherapy were 0.803, 0.766 and 0.554, respectively. Compared with chemoradiotherapy, the addition of EGFR inhibitors did not significantly increase the risk of grade ≥3 pneumonitis and esophagitis. Conclusion: EGFR-tyrosine kinase inhibitors combined with (chemo)radiotherapy are tolerable and the clinical benefit is promising, especially in patients with EGFR-sensitive mutations.

Background With remarkable success and few side effects, induction chemoimmunotherapy has been used to improve the prognosis of patients with resectable or potentially resectable non-small cell lung cancer (NSCLC), even in stage III disease. However, for patients who are medically inoperable, unresectable or refuse surgery after induction chemoimmunotherapy, it is unclear whether patients should be treated with concurrent chemoradiotherapy (cCRT) or radiotherapy (RT) alone considering patient safety and tolerability. This study aimed to determine whether cCRT is safe and superior to RT alone after chemoimmunotherapy for stage III NSCLC. Methods Patients diagnosed with stage III NSCLC who received chemoimmunotherapy followed by cCRT/RT alone without surgery at Tianjin Cancer Hospital between November 2018 to December 2021 were retrospectively collected. Patients were divided into two groups: induction chemoimmunotherapy followed by cCRT (cCRT cohort) or RT alone (RT alone cohort). Kaplan-Meier method was used to estimate survival. Univariate and multivariate Cox regression models were adopted to estimate risk factors for PFS. Results Sixty-five patients were included, with 44 (67.7%) received RT alone and 21 (32.3%) received cCRT. Patients in the cCRT group had significantly prolonged PFS (HR = 0.155, p = 0.004), LPFS (HR = 0.225, p = 0.029) and DMFS (HR = 0.028, p = 0.006) than those in the RT alone group. Albeit nonsignificant, a trend toward improved OS (HR = 0.030, p = 0.069) was also observed in the cCRT group. The multivariate analysis further confirmed that cCRT (HR = 0.141, p = 0.008) was the independent factor for promoting a favorable PFS. Treatment-related adverse events were similar between groups (p > 0.05). Patients with consolidation immunotherapy exhibited a trend of improved PFS (HR = 0.398, p = 0.274) and numerically better OS (HR = 0.018, p = 0.209) compared with those without. Conclusions For patients with unresectable stage III NSCLC, cCRT following chemoimmunotherapy appears to be safe and may prolong survival compared with radiotherapy alone. Further investigations on the combination of chemoimmunotherapy and CRT are warranted.

Objective Currently, the value of induction chemoimmunotherapy before chemoradiotherapy (CRT) in unresectable stage III non-small cell lung cancer (NSCLC) has not been established. This study aimed to investigate the role of induction chemoimmunotherapy for unresectable stage III NSCLC. Patients and Methods Patients diagnosed with stage III NSCLC who received CRT at Tianjin Cancer Hospital between August 2014 and December 2021 were retrospectively analysed. Based on induction chemoimmunotherapy or not, patients were allocated to I-CRT group or CRT group. Clinical outcomes including progression-free survival (PFS) and overall survival (OS) were estimated. Results A total of 255 patients were included, with 51 (20.0%) in the I-CRT group and 204 (80.0%) in the CRT group. The median PFS was 24.8 months in the I-CRT group vs. 12.6 months in the CRT group (p = 0.004), and the median OS was not reached (NR) vs. 32.4 months (p = 0.040). The multivariate analysis showed that induction chemoimmunotherapy was the independent factor favoring PFS (HR = 0.497, p = 0.003) and OS (HR = 0.459, p = 0.038). No significant differences were found in adverse effects (p > 0.05). The objective response rate (ORR) after induction chemoimmunotherapy was significantly higher than that after induction chemotherapy (56.9% vs. 22.2%, p = 0.000). Patients with induction chemoimmunotherapy before concurrent chemoradiotherapy had prolonged PFS (median NR vs. 14.9 months, p = 0.012) and OS (median NR vs. 26.5 months, p = 0.074) compared to those with induction chemotherapy. Conclusion Induction chemoimmunotherapy may improve outcomes to CRT and is well tolerated for unresectable stage III NSCLC patients. Prospective randomized trials need to be performed to further validate these findings.

Purpose: To investigate the prognostic differences between small-cell lung cancer (SCLC) patients with different chemosensitivity to first line chemotherapy who developed brain metastasis as first site of progression. Methods: Patients with brain metastases (BMs) after first-line treatment of SCLC in our hospital admitted from January 2012 to October 2020 were retrospectively analyzed. According to the time interval between the completion of first-line chemotherapy and the onset of BMs (TFI), the patients were divided into chemo-sensitive group (TFI ≥ 90 days, n = 145) and chemo-resistant group (TFI ＜ 90 days, n = 97). Survival time after the onset of brain metastasis (BM-OS), which was calculated from the diagnosis of brain metastases and overall survival (OS), which was calculated from the diagnosis of small-cell lung cancer, were analyzed in this study. Survival curves were plotted using Kaplan-Meier method and differences between groups were compared using the log-rank test. The Chi-square test or Fisher’s exact test was used to compare categorical variables. Results: In total, the median BM-OS and OS were 8.4 months and 18.2 months respectively. The median BM-OS in chemo-sensitive group was 8.8 months and it was 8.0 months in the chemo-resistant group (P = 0.538); and the median OS was 22.0 months and 15.6 months, respectively (P = 0.001). In patients without extracranial progression (n = 193), the median BM-OS in chemo-sensitive and chemo-resistant group were 9.4 months and 9.7 months (P = 0.947), and the median OS were 22.7 months and 16.3 months, respectively (P = 0.017). In patients with extracranial progression (n = 49), the median BM-OS were 5.4 months and 4.2 months (P = 0.161), and the median OS were 17.6 months and 12.3 months, respectively (P = 0.002). Conclusions: After the development of brain metastasis as the first site of progression following chemotherapy in small cell lung cancer, the prognosis of chemo-sensitive patients not necessarily superior to chemo-resistant patients, especially in patients without extracranial progression.