Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer · 2026
Disease Kinetics and Practice Patterns in More Than or Equal to 4-Year Long-Term Beneficiaries of Immune Checkpoint Inhibitors for Advanced NSCLC.
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Torasawa Masahiro, Masui Yoshihiro, Miura Keita, Kataoka Shunichi, Shirasawa Masayuki, Nakahara Yoshiro, Baba Junko, Ishii Hidenobu, Asai Maiko, Aiba Tomoiki, Wakui Hiroshi, Sugawara Shunichi, Hosomi Yukio, Tanaka Hiroshi, Naoki Katsuhiko, Takahashi Kazuhisa, Kenmotsu Hirotsugu, Horinouchi Hidehito
Аннотация
INTRODUCTION: Immune checkpoint inhibitors (ICIs) have enabled durable responses in a subset of patients with advanced NSCLC; however, the clinical trajectories and patterns of late disease progression among long-term survivors remain poorly characterized.
METHODS: This multicenter retrospective study enrolled patients with advanced NSCLC who received ICI-containing therapy between January 2015 and April 2020. Long-term beneficiaries (LTBs) were defined as patients who achieved both an overall survival (OS) of more than or equal to 4 years and a time to next cytotoxic chemotherapy of more than or equal to 4 years. We performed 4-year landmark analyses, characterized late progression (first radiographic progression ≥4 y from ICI initiation), and evaluated cause-specific mortality using competing risk analysis.
RESULTS: Of 3144 patients, 537 (17%) survived more than or equal to 4 years, and 295 (9.4%) were LTBs (median follow-up: 68.6 mo); only 8.1% were lost to follow-up at the data cutoff. ICI was initiated as first-line therapy in 63% of the patients. Among the 235 LTBs without progression at 4 years, 66% discontinued ICI. The lung cancer-specific OS rates were 97.8% and 88.0% at 6 and 8 years, respectively. Late progression occurred in 26 patients (11.1%); all had less than or equal to five lesions, and 84.6% demonstrated indolent progression with growth speeds less than or equal to 10 mm/mo. Local therapy was selected in 42% of the patients after progression. Of 22 deaths more than or equal to 4 years post-ICI, only seven (32%) were lung cancer related, whereas 15 (68%) were from other causes, including secondary malignancies. Competing risk analysis revealed that other-cause mortality consistently exceeded lung cancer-related mortality.
CONCLUSIONS: LTBs without progression at 4 years achieved durable control, with lung cancer-specific OS approaching 90% at 8 years of follow-up. Late progression is uncommon, limited in extent, and often treated locally. The predominance of non-lung cancer-related mortality underscores the importance of comprehensive survivorship care.
METHODS: This multicenter retrospective study enrolled patients with advanced NSCLC who received ICI-containing therapy between January 2015 and April 2020. Long-term beneficiaries (LTBs) were defined as patients who achieved both an overall survival (OS) of more than or equal to 4 years and a time to next cytotoxic chemotherapy of more than or equal to 4 years. We performed 4-year landmark analyses, characterized late progression (first radiographic progression ≥4 y from ICI initiation), and evaluated cause-specific mortality using competing risk analysis.
RESULTS: Of 3144 patients, 537 (17%) survived more than or equal to 4 years, and 295 (9.4%) were LTBs (median follow-up: 68.6 mo); only 8.1% were lost to follow-up at the data cutoff. ICI was initiated as first-line therapy in 63% of the patients. Among the 235 LTBs without progression at 4 years, 66% discontinued ICI. The lung cancer-specific OS rates were 97.8% and 88.0% at 6 and 8 years, respectively. Late progression occurred in 26 patients (11.1%); all had less than or equal to five lesions, and 84.6% demonstrated indolent progression with growth speeds less than or equal to 10 mm/mo. Local therapy was selected in 42% of the patients after progression. Of 22 deaths more than or equal to 4 years post-ICI, only seven (32%) were lung cancer related, whereas 15 (68%) were from other causes, including secondary malignancies. Competing risk analysis revealed that other-cause mortality consistently exceeded lung cancer-related mortality.
CONCLUSIONS: LTBs without progression at 4 years achieved durable control, with lung cancer-specific OS approaching 90% at 8 years of follow-up. Late progression is uncommon, limited in extent, and often treated locally. The predominance of non-lung cancer-related mortality underscores the importance of comprehensive survivorship care.