Dr Sekkath Veedu on Survival Outcomes With Surgery vs Chemoradiation in Stage IIIA NSCLC

Janeesh Sekkath Veedu, MBBS, GME fellow, Internal Medicine, University of Kentucky College of Medicine, discusses the survival advantage conferred by surgical-based treatment compared with definitive chemoradiation in patients with stage IIIA non–small cell lung cancer (NSCLC).

There are currently 2 main treatment approaches in stage IIIA NSCLC: surgery-based treatment and definitive chemoradiation followed by durvalumab (Imfinzi) consolidation. Despite the known benefit of both approaches in this space, a direct comparison of real-world outcomes had not yet been performed since the introduction of durvalumab in the treatment paradigm.

In an effort to answer this question, a real-world, large-scale database analysis of survival outcomes and long-term disease control was evaluated for both approaches. The study utilized the National Cancer Database (NCDB) to identify patients with clinical stage IIIA NSCLC treated with either approach during 2017 to 2019 and 2014 to 2016.

Findings from the analysis showed that surgery-based treatment elicited a survival benefit in patients across all groups in 2014 to 2016, Sekkath Veedu states. Following the introduction of immune checkpoint inhibitors (ICIs) to chemoradiation in late 2017, surgery-based treatment still provided a superior survival benefit in patients with operable/resectable stage IIIA NSCLC, Sekkath Veedu adds. However, surgery has a slight disadvantage over the chemoradiation regimen in the first year of treatment due to up-front surgical mortality, though this was consistent with previously known data. Additionally, the use of chemoradiation plus ICIs provided a higher survival benefit to patients in comparison with chemoradiation alone.

Based on these findings, patients with resectable stage IIIA NSCLC should be recommended forsurgery, although chemoimmunotherapy is still a viable option for patients who are ineligible for resection, Sekkath Veedu states.

Next steps for this research may include an expanded analysis of survival outcomes with each approach according to racial differences, Sekkath Veedu continues. The addition of data from 2020 to 2021 to the NCDB database would enable this analysis to be conducted in a larger patient pool, as the original cut-off was 2019, he explains. As the introduction of immunotherapy has only occurred in the last several years, these new data would allow investigators to more accurately represent the influence of immunotherapy on differences in survival benefit with the chemoradiation approach vs surgery, Sekkath Veedu concludes.