Value of local therapy in unresectable non-small cell lung cancer receiving immune checkpoint inhibitor-based treatment: a retrospective study

Abstract Background Immune checkpoint inhibitors (ICIs) have transformed systemic therapy for unresectable epidermal growth factor receptor (EGFR) mutation-negative non-small cell lung cancer (NSCLC). However, the role of complementary radical local therapy (LT) in locally advanced NSCLC (LA-NSCLC) receiving ICI-based therapy remains unclear. We evaluated recurrence patterns, survival outcomes, and subgroups benefiting from LT. Methods This retrospective study included 206 patients with unresectable NSCLC receiving ICI-based systemic therapy, divided into radical LT and non-LT groups. Of the 206 patients, 124 received radical LT combined with ICIs and 82 received ICI-based therapy without local intervention. Median follow-up was 40.4 months. Clinicopathological characteristics, recurrence patterns, and survival outcomes were compared. Multivariate Cox regression and subgroup analyses identified prognostic factors and populations benefiting from LT. Results Overall recurrence rates were comparable; LT was associated with delayed recurrence, less early locoregional relapse, and more isolated distant metastasis. Median progression-free survival (PFS) and overall survival (OS) were significantly longer in the LT group. Radical LT was an independent favorable prognostic factor for PFS and OS. Benefits were more prominent in patients with squamous cell carcinoma, stage IIIB–IIIC disease, programmed death-ligand 1 (PD-L1) tumor proportion score of 0–49%, initial stable or progressive disease, and fewer ICI cycles. Conclusions In summary, radical LT may delay progression and modify recurrence patterns in unresectable NSCLC receiving ICI-based therapy. Histology, PD-L1 expression, disease stage, and initial immunotherapy response may help identify candidates for multimodal therapy.