Management of non-small cell lung cancer after 2 years of immunotherapy Experience of a French center - 26/03/25

Doi : 10.1016/j.resmer.2025.101169

Cédric Mahiat ^a,^⁎ , Jacques Cadranel ^a, Constance Méteyé ^a, Samy Houari ^b, Lise Rosencher ^a, Christelle Epaud ^a, Jérémy Slomka ^a, Vincent Fallet ^a, Anthony Canellas ^a
^a Department of Pneumology and Thoracic Oncology, Tenon Hospital, Assistance publique-Hôpitaux de Paris and Sorbonne University, Paris, France
^b Department of Pharmacy, Tenon Hospital, Assistance publique-Hôpitaux de Paris and Sorbonne University, Paris, France

^⁎Corresponding author. Cédric Mahiat, Service de pneumologie, Hôpital Tenon, 4, Rue de la Chine, 75970, ParisService de pneumologieHôpital Tenon4, Rue de la ChineParis75970

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Abstract

Background

The optimal management strategy for metastatic or advanced-stage non-small-cell lung cancer (NSCLC) after 2 years of immune checkpoint inhibitor (ICI) remains unclear.

Methods

We conducted a single-center retrospective observational study to characterize the management of patients who received at least 2 years of ICI in the first-line setting for a metastatic or advanced-stage NSCLC.

Results

Among the 254 patients that received ICI in the first-line setting, 39 (15%) achieved 2 years of treatment (ICI in monotherapy, n=14; ICI with chemotherapy, n=25). ICI was discontinued after 2 years (<30 months) in 31 (79%) of the cases. During the first 2 years, 29 patients (74%) had no disease progression (2 complete radiological responses, 25 partial radiological responses, and 2 stable diseases) and 10 patients (26%) experienced at least one oligo-progression, which was treated with local ablative treatment (LAT), allowing continuation of ICI up to 2 years. A positron emission tomography (PET) scan was performed at 2 years for 37 patients (95%), revealing a complete metabolic response (CMR) in 16 individuals (43%). None of these patients progressed subsequently (median follow-up: 13 months). After 2 years of ICI, the 12-month progression-free survival was 100% in case of CMR versus 49% (95% CI, 29-91) in the absence of CMR (p=0.00037).

Conclusions

A CMR at 2 years of ICI is associated with a favorable prognosis. Further studies are needed to better establish the role of PET scan at 2 years, the relevance of LAT and the optimal duration of ICI.

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Keywords : Duration of Therapy, Immune checkpoint inhibitors, Immunotherapy, Lung neoplasms, Non-Small-Cell Lung Carcinoma

Abbreviations : ALK, bMRI, CI, CMR, CR, CT, ECOG PS, EGFR, HR, ICI, LAT, L1, L+, NR, NSCLC, OR, ORR, OS, PFS, PET, PR, SD, TFS