Should Immunotherapy Move Upfront in Unresectable Stage III NSCLC? (2025)
Flipping the script in unresectable stage III non-small cell lung cancer (NSCLC) by giving neoadjuvant chemoimmunotherapy followed by chemoradiation has the potential to improve outcomes for patients with this difficult-to-treat disease, a team of investigators asserts. The current standard of care for stage III unresectable NSCLC is chemoradiation followed by consolidation with the immune checkpoint inhibitor (ICI) durvalumab (Imfinzi), based on results of the phase 3 PACIFIC trial . However, Rajat Thawani, MD, and colleagues from the University of Chicago argue that upfront platinum-based chemotherapy with an ICI may help preserve the immune function of tumor-draining lymphatics. In contrast, immunotherapy administered concurrently with chemoradiation attenuates systemic immunity responses to checkpoint blockade, they say. “Tumor-draining lymph nodes serve as the site for T-cell activation in mounting an antitumor immune response ...