Consolidative Thoracic Radiotherapy With Atezolizumab Maintenance in Extensive-Stage Small Cell Lung Cancer

Is consolidative thoracic radiotherapy (TRT) added to standard immunotherapy maintenance in first-line extensive-stage small cell lung cancer (ES-SCLC) safe and more effective than immunotherapy alone?This phase 2 randomized clinical trial found that TRT plus immunotherapy unexpectedly resulted in significantly more frequent and severe toxic effects, particularly infections, without improving survival; therefore, recruitment was halted prematurely. Persistent lymphocyte depletion after TRT suggested a potential contributor to the observed toxic effects.These findings indicate that in unselected patients with ES-SCLC, consolidative TRT combined with immunotherapy maintenance increased toxic effects without efficacy benefit, arguing against routine use other than in carefully selected patients; further investigation of radiation-induced lymphocyte depletion as a potential risk factor is warranted.

Corresponding Author: Farastuk Bozorgmehr, MD, Department of Thoracic Oncology, Thoraxklinik Heidelberg gGmbH, Röntgenstrasse 1, 69126 Heidelberg, Germany (farastuk.bozorgmehr@med.uni-heidelberg.de).

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