The following is a summary of “Selective Personalized RadioImmunotherapy for Locally Advanced Non–Small-Cell Lung Cancer Trial (SPRINT),” published in the November 2023 issue of Oncology by Ohri, et al.

The standard therapy for locally advanced non–small-cell lung cancer (LA-NSCLC) involves concurrent chemoradiotherapy followed by adjuvant durvalumab. For a study, researchers sought to assess the tolerability and efficacy of sequential pembrolizumab and risk-adapted radiotherapy, without chemotherapy, in biomarker-selected patients with LA-NSCLC.

Eligible patients included those with stage III NSCLC or unresectable stage II NSCLC and an Eastern Cooperative Oncology Group performance status of 0-1. Patients with a PD-L1 tumor proportion score (TPS) of ≥50% received three cycles of induction pembrolizumab (200 mg, once every 21 days), followed by a 20-fraction course of risk-adapted thoracic radiotherapy (55 Gy delivered to tumors or lymph nodes with metabolic volume exceeding 20 cc, 48 Gy delivered to smaller lesions), and consolidation pembrolizumab to complete a 1-year treatment course. The primary endpoint was 1-year progression-free survival (PFS), with secondary endpoints including response rates, overall survival (OS), and adverse events.

Twenty-five patients with a PD-L1 TPS of ≥50% were enrolled, with a median age of 71 and most having stage IIIA or IIIB disease. The median PD-L1 TPS was 75%. Two patients experienced disease progression during induction pembrolizumab, and two discontinued pembrolizumab due to immune-related adverse events. About 48% (12/25) of patients exhibited a partial or complete response after induction pembrolizumab. 96% (24/25) received definitive thoracic radiotherapy. The 1-year PFS rate was 76%, meeting the efficacy objective. One- and 2-year OS rates were 92% and 76%, respectively. The most common grade 3 adverse events were colitis (n = 2, 8%) and esophagitis (n = 2, 8%), and no higher-grade treatment-related adverse events occurred.

Sequential pembrolizumab and risk-adapted radiotherapy, without chemotherapy, show promise as a treatment approach for LA-NSCLC patients with a PD-L1 TPS of ≥50%.

Reference: ascopubs.org/doi/10.1200/JCO.23.00627