Efficacy of Bronchial Artery Infusion/Chemoembolization Combined with Platinum-Based Chemotherapy and PD-1 Inhibitor in Initially Unresectable Stage III Non-Small Cell Lung Cancer.

Résumé

BACKGROUND: To evaluate the efficacy of bronchial arterial infusion/bronchial arterial chemoembolization (BAI/BACE) combined with platinum-based doublet chemotherapy and PD-1 inhibitor in patients with initially unresectable stage III non-small cell lung cancer (NSCLC).METHODS: This retrospective study analyzed 42 patients with initially unresectable stage III NSCLC treated between September 2020 and March 2025. Patients were divided into the BAI group (n=20), which received BAI/BACE combined with platinum-based doublet chemotherapy and PD-1 inhibitor, and the Non-BAI group (n=22), which received platinum-based doublet chemotherapy and PD-1 inhibitor alone. Objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were compared between the groups. Patients were further categorized into the surgery group (n=19) and the Non-surgery group (n=23) whether they underwent resection after induction therapy, and their survival outcomes were compared.RESULTS: The overall ORR was 64.3%. The ORR of the BAI group was significantly higher than the Non-BAI group (80.0% vs 50.0%, 0.043). Survival analysis showed that the 2-year PFS and OS rates for the entire cohort were 41.2% and 64.3%, respectively. The BAI group had significantly better 2-year PFS (52.8% vs 29.1%, 0.032) and OS (78.3% vs 51.7%, 0.022) than the Non-BAI group. Treatment-related adverse events were predominantly grade I-II, with no significant differences between groups. Following induction therapy, 64.3% (27/42) of patients achieved successful downstaging, and the surgical conversion rate was 45.2% (19/42). The pathological complete response (pCR) and major pathological response (MPR) rates were 10.5% (2/19) and 36.8% (7/19), respectively. Furthermore, the surgery group showed significantly better 2-year PFS (64.8% vs. 20.7%, =0.001) and OS (93.8% vs. 39.6%, =0.001) than the Non-surgery group.CONCLUSION: BAI/BACE combined with immunochemotherapy demonstrates promising efficacy and a manageable safety profile in the conversion therapy of initially unresectable stage III NSCLC. Successful downstaging followed by surgery is associated with improved survival outcomes. Nevertheless, given the small sample size and retrospective design, these findings should be considered exploratory and warrant validation in larger prospective studies.