S806
Clinical - Lung
ESTRO 2026
Purpose/Objective: Concurrent chemoradiotherapy followed by durvalumab consolidation is the current standard of care for unresectable stage III non–small cell lung cancer(NSCLC), as established by the PACIFIC1 trial. However, several studies are exploring alternative radiotherapy(RT)– immunotherapy (IO) integration strategies with different sequencing and timing approaches. This systematic review summarizes published and ongoing prospective trials evaluating RT–IO combinations in this setting. Material/Methods: A systematic search following the PRISMA guidelines of PubMed and ClinicalTrials.gov (January 1, 2000– November 1, 2025) identified all prospective trials combining IO and RT in unresectable stage III NSCLC, including published studies and abstracts. Trials were categorized into four groups: 1. Concurrent chemoradiotherapy followed by IO consolidation; 2. Concurrent chemoradiotherapy combined with concurrent IO; 3. Induction IO ± chemotherapy followed by concurrent chemoradiotherapy; 4. Radiotherapy combined with IO without chemotherapy. Results: A total of 12,366 studies were screened, 173 were assessed for eligibility, and 75 met the inclusion criteria. Thirty-one studies evaluated concurrent chemoradiotherapy followed by IO consolidation, of which three phase III trials have reported positive results: PACIFIC1: mOS 47.5 vs 29.1months (HR:0.72 [95%CI:0.59–0.89]); mPFS 16.9 vs 5.6 months (HR:0.55 [95%CI:0.45–0.68]); 5-year-OS 42.9% vs 33.4%; 5-year- PFS 33.1% vs 19.0%. GEMSTONE-3012: mPFS 9.0 vs 5.8 months (HR:0.64 [95%CI:0.48–0.85]; p=0.0026).PACIFIC-53: mPFS 14.0 vs 6.5 months (HR:0.75 [95%CI:0.58–0.99]; p=0.038). One trial reported negative results: SKYSCRAPER-034:RF-PFS: 14.2 vs 13.8 months (HR:1.00 [95%CI:0.84-1.19]); mOS: 45.6 vs 45.8 months (HR:0.98 [95%CI:0.80-1.20]). Six additional phase III trials are ongoing in this category.Sixteen studies investigated concurrent chemoradiotherapy combined with concurrent IO, with three phase III trials having reported negative results: CheckMate73L5: mPFS 16.7 vs 15.6 months (HR:0.95 [95%CI:0.77–1.19]; p=0.6461). PACIFIC-26: mPFS 13.8 vs 9.4 months (HR:0.85 [95%CI:0.65–1.12]; p=0.247). EA51817: mOS: 41.5 vs 39.4 months (HR:1.03 [95%:CI:0.80–1.32] p= 0.83); mPFS: 15.5 vs 16.4 months (HR:1.05 [95%CI:0.86–1.29] p=0.65). Two additional phase III trials are ongoing in this group.Fifteen studies explored induction IO ± chemotherapy followed by concurrent chemoradiotherapy, and thirteen assessed RT combined with IO without chemotherapy; no phase III trials have been published or are currently ongoing in these categories.
of SABR as a curative alternative to surgery, particularly in older people, and demonstrate how high-quality ‘real-world evidence’ can complement RCT results as they become available. References: Kagenaar, E., Lugo-Palacios, D.G., Hutchings, A., Aggarwal, A., O’Neill, S., Rachet, B., Edwards, J., Faivre- Finn, C., Grieve, R., 2025. Surgery or radiotherapy for early-stage cancer study (SORT) target trial protocol: stereotactic ablative radiotherapy (SABR) with curative intent versus surgical resection for early-stage non- small cell lung cancer (NSCLC). BMJ Open 15, e103038. https://doi.org/10.1136/bmjopen-2025-103038 Keywords: Non-small cell lung cancer, SABR, surgery unresectable locally advanced non-small cell lung cancer: A systematic review from the Y-ECI ROSC EORTC Group. Victor Duque-Santana 1,2 , Dora Correia 3,4 , Andrada Turcas 5,6 , Felix Ehret 7,8 , Carolina de la Pinta 9,10 , Anne G.H. Niezink 11 , Tiuri E. Kroese 12 , Tomá š Kazda 13 , Antonin Levy 14 , Corinne Faivre-Finn 15 , Jonas Willmann 12 1 Radiation Oncology, Hospital Universitario Quironsalud Madrid, Madrid, Spain. 2 Department of Medicine, Faculty of Medicine, Health and Sports, European University of Madrid, Madrid, Spain. Digital Poster 3039 Radiotherapy and immunotherapy for 3 Radiation Oncology, Cantonal Hospital Aarau, Aarau, Aargau, Switzerland. 4 Radiation Oncology, , Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland. 5 Institute of Advanced Studies in Science and Technology, Babe ș -Bolyai University, Cluj-Napoca, Romania. 6 Radiation Oncology, Oncology Institute “Prof. Dr. Ion Chiricuta”, Cluj-Napoca, Romania. 7 Radiation Oncology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany. 8 German Cancer Consortium (DKTK), partner site Berlin, a partnership between DKFZ and Charité, Universitätsmedizin Berlin, Berlin, Germany. 9 Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain. 10 Biomarkers and Therapeutic Targets Group, Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain. 11 Radiation Oncology, University Medical Center Groningen, Groningen, Netherlands. 12 Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 13 Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic. 14 Radiation Oncology, Gustave Roussy, Villejuif, France. 15 Radiation Oncology, The Christie NHS Foundation trust & The university of Manchester, Manchester, United Kingdom
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