S774
Clinical - Lung
ESTRO 2026
1 Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, Australia. 2 School of Medicine and Public Health, University of Newcastle, Newcastle, Australia. 3 Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, Australia. 4 Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, Australia. 5 Westmead Clinical School, University of Sydney, Westmead, Australia. 6 Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia. 7 Liverpool & Macarthur Cancer Therapy Centres, Liverpool & Campbelltown Hospitals, Sydney, Australia. 8 South West Sydney Clinical Campuse, Faculty of Medicine, University of New South Wales, Sydney, Australia Purpose/Objective: By shortening overall treatment duration, moderately hypofractionated chemoradiation (CRT) for unresectable Stage III non-small cell lung cancer (NSCLC) can reduce treatment burden and improve patient access and acceptability to curative-intent therapy. However, historical concerns regarding toxicity and lack of contemporary outcome data have limited its widespread adoption. 1 Thus, 6-week conventional CRT followed by consolidation durvalumab remains the standard of care, as established by the PACIFIC trial.2 The MODERN-LUNG phase II prospective study evaluates the safety and efficacy of a 4-week moderately hypofractionated CRT regimen followed by consolidation immunotherapy.This report presents the toxicities and early outcomes of the first 45 patients treated with moderately hypofractionated CRT on a single arm, prospective phase 2 trial. Material/Methods: Forty-five patients were treated across four Australian centres with 55 Gy delivered in 20 fractions over 4 weeks (2.75 Gy/fx) with concurrent weekly paclitaxel and carboplatin. Suitable patients proceeded to consolidation durvalumab. The primary endpoints were rates of acute radiation-related esophagitis and pneumonitis. Demographics, treatment characteristics, toxicities, and disease status were prospectively recorded. Survival outcomes were estimated using the Kaplan–Meier method. Results: Between May 2021 and September 2025, 45 patients completed CRT. Median age was 70 years (range 47– 85), 53% were female, 93% were ever-smokers, and 89% had ECOG performance status 0–1. Histologies included adenocarcinoma (49%) and squamous cell carcinoma (42%); two patients had EGFR-mutated disease. At 6-week follow-up, grade 3 esophagitis occurred in 3/45 patients (6.7%), with no grade 4–5 events. At 3 months, grade 2 pneumonitis occurred in 7/40 evaluable patients (17.5%), with no grade ≥ 3 pneumonitis. 83% commenced consolidation
durvalumab. With a median follow-up of 22 months, no grade ≥ 3 late esophageal toxicities have been observed, median progression-free survival is 24 months and overall survival is 93% at 12 months and 75% at 24 months. Conclusion: This 4-week moderately hypofractionated CRT regimen followed by consolidation immunotherapy demonstrated acceptable acute toxicity and early survival outcomes, comparable to conventional 6- week CRT. Treatment schedule reduction offers potential benefits for patient experience and healthcare resource utilisation. These findings provide the foundation for the planned MODERN-LUNG phase III international randomised trial comparing 4-week versus 6-week CRT. References: 1. Ludbrook JJ, Kumar M, Soon YY, Smith A, Mallesara G, Hau E, et al. Efficacy and Safety of Four Weeks of Moderately Hypofractionated Chemoradiation for Unresectable, Stage 3 Non-Small Cell Lung Cancer: A Systematic Review. Asia Pac J Clin Oncol. 2025;21(4):359-67. doi: 10.1111/ajco.14152.2. Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, Hui R, et al. Durvalumab after chemoradiotherapy in stage III non–small-cell lung cancer. New England Journal of Medicine. 2017;377(20):1919-29. doi: 10.1056/NEJMoa1709937. Keywords: Hypofractionation chemoimmunotherapy in metastatic non-small lung cancer - a prospective, phase II study PRIMM (NCT 05440916) Tanja Ž nidari č Rakar 1,2 , Marina Č ak š 1 , Eva Ć iri ć 3,4 , Rok Devjak 5 , Marija Ivanovi ć 1 , Ur š ka Jan ž i č 6,4 , Tamara Jarm 7 , Katja Mohor č i č 6 , Loredana Mrak 6 , Nata š a Pulko 1 , Nina Turn š ek 5,4 , Mojca Unk 5,4 , Jure Verban č i č 1 , Jasna But- Had ž i ć 3,4 1 Department of Oncology, University Medical Centre Maribor, Maribor, Slovenia. 2 Department of Oncology, University of Maribor, Faculty of Medicine, Maribor, Slovenia. 3 Division of Radiation Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia. 4 Department of Oncology, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia. 5 Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia. 6 Department of Medical Oncology, University Clinic Golnik, Golnik, Slovenia. 7 Department of Medicine, University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia Mini-Oral 1782 Upfront palliative radiotherapy prior to
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