Objective
To compare the efficacy and safety of a sequential combination of chemoradiotherapy (CRT) with immune checkpoint inhibitors (ICIs) administered as induction plus consolidation versus consolidation-only in patients with unresectable stage III non-small cell lung cancer (NSCLC).
Methods
This retrospective study enrolled 265 patients treated at two centers between March 2019 and August 2023. Patients were categorized into a consolidation-only group (n = 153) and an induction plus consolidation group (n = 112). Propensity score matching (PSM, 1:1 ratio) was used to balance baseline characteristics. Progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier analysis and log-rank tests. Adverse events (AEs) were evaluated according to CTCAE v5.0.
Results
Before PSM, no significant survival differences were observed between groups (2-y PFS: 52.6% vs. 63.5%, p = 0.085; 2-y OS: 91.7% vs. 81.2%, p = 0.822). After PSM, outcomes remained comparable (2-y PFS: 56.8% vs. 62.2%, p = 0.179; 2-y OS: 94.9% vs. 87.9%, p = 0.514). Before PSM, the most common AE was pneumonitis (60.7% vs. 55.1%, p = 0.442). The induction plus consolidation group showed a lower incidence of anemia (p = 0.004) but a higher incidence of ALT/AST elevation (14.3% vs. 5.1%, p = 0.022). The incidence of all other AEs was comparable (p > 0.05). After PSM, only anemia was significantly higher in the consolidation-only group (52.8% vs. 27.8%, p = 0.004).
Conclusion
In treatment-tolerant patients, induction plus consolidation therapy demonstrated comparable efficacy and safety to consolidation-only therapy in unresectable stage III NSCLC.