SYSTEMATIC LITERATURE REVIEW FOR TREATMENT OUTCOMES (INCLUDING IMMUNO-ONCOLOGY TREATMENT) AMONG PATIENTS WITH STAGE 3 UNRESECTABLE NON-SMALL CELL LUNG CANCER (NSCLC)

Immuno-oncology (IO) agents are being developed as a treatment option for patients with stage 3 unresectable NSCLC. This study aims to understand the comparative clinical efficacy of maintenance/consolidation therapies, including IO agents, for stage 3 NSCLC patients who have not progressed after completing chemoradiation therapy (CRT). A systematic literature review of Medline, EMBASE and Cochrane Library was performed to identify randomised clinical trials (RCTs) satisfying the following criteria: 1) included adults with stage 3 unresectable NSCLC, 2) included at least one arm with concurrent CRT, 3) reported efficacy or safety outcomes, 4) published in 2002 or later. Twenty-five RCTs were identified. Among them, five RCTs compared consolidation/maintenance therapy versus placebo post-CRT. Median progression-free survival (PFS) was 6.4–10.8 months in consolidation/maintenance arms, and 5.5–11.7 months in placebo arms. Median OS was 16.1–25.6 months in consolidation/maintenance arms, and 18.5–35.0 months in placebo arms (HR ranged from 0.88 to 1.59). Seven RCTs compared concurrent CRT regimens. These studies reported median PFS of 8.4–17.5 months and median OS of 13.5–30.0 months. Seven RCTs compared concurrent vs. sequential CRT. Median PFS was 6.7–17.0 months in concurrent arms and 9.0–12.1 months in sequential arms. Median OS was 12.7–24.3 months in concurrent arms and 12.9–18.4 months in sequential arms (HR ranged from 0.61 to 0.92). The remaining 6 RCTs compared other CRT regimens. Detailed network meta-analysis results including PFS outcomes from a phase 3 trial will be presented after primary clinical results are presented at ESMO 2017. Little evidence was found that chemotherapy agents as post-CRT consolidation therapy can improve survival outcomes. In addition, concurrent CRT showed improved efficacy vs sequential CRT, while the commonly used concurrent CRTs showed no clinically meaningful difference in treatment outcomes.