Comprehensive Patient Reported Outcomes (PROs) from NRG Oncology/Alliance LU005: A Randomized Trial Of Chemoradiation +/- Atezolizumab In Limited-Stage Small Cell Lung Cancer
In brief
Twice-daily radiation improves quality of life versus once-daily in limited-stage SCLC
In the NRG-LU005 trial of 544 patients, adding atezolizumab to chemoradiation did not change long-term quality-of-life scores, but patients who received twice-daily thoracic radiation reported consistently higher FACT-TOI scores than those on once-daily schedules through 21 months. The finding suggests a potential symptom benefit of the more intensive radiation regimen, though the study was not randomized for radiation schedule.
- Journal
- Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer (Q1)
- Published
- 30 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Benjamin Movsas, Chen Hu, Kristin A Higgins, Helen J Ross, Salma K Jabbour, David Kozono, et al.
- PMID
- 42532339
- DOI
- 10.1016/j.jtho.2026.104117
Why clinicians should know about it
- Picked for Radiation Oncology (top studies of the week, 11 October 2026): BID-RT associated with better FACT-TOI
Abstract
PURPOSE: While NRG-LU005 showed no overall survival (OS) advantage by adding concurrent and adjuvant immunotherapy to chemoRT (CRT), it reported longer OS in an exploratory comparison of twice-daily (BID) over once-daily (QD) radiation (RT). This planned analysis assessed longitudinal PROs. The pre-specified hypothesis was that clinically-meaningful-decline (CMD) in longer term PROs at 15 months would be lower with immunotherapy, as measured by the Functional-Assessment-of-Cancer-Therapy:Trial-Outcome-Index (FACT-TOI). METHODS: Patients (N=544) were randomized to standard CRT (platinum/etoposide + thoracic-RT [45Gy-BID or 66Gy-QD]) +/- atezolizumab starting cycle-2 of chemotherapy. Stratification factors (SFs) included RT-schedule, chemotherapy-type, sex, and performance-status(PS). PROs included validated instruments: FACT-TOI, EQ-5D-5L, and PROMIS-Fatigue (at baseline, end-of-CRT, and at 3, 6, 15, and 21 months). EQ-5D-5L scores were followed through 24 months. CMD and longitudinal trends were evaluated; multivariable logistic regression analysis (MVA) adjusted for treatment-arm, SFs, and baseline FACT-TOI. RESULTS: PRO compliance exceeded 85% at baseline and stabilized at 60-68% through 21 months. CMD in FACT-TOI was not significantly different by treatment arm at 15 months, though fewer patients on the immunotherapy arm had CMD at 21 months. EQ-5D-5L and PROMIS-fatigue were similar in both arms. BID-RT was associated with better FACT-TOI than QD-RT across all timepoints. On MVA, significant predictors of lower CMD for FACT-TOI (beyond baseline FACT-TOI) included BID-RT (at end-of-CRT, 15, 21 months), PS (at end-of-CRT), cisplatin (at 15 months), and immunotherapy (at 21 months). CONCLUSIONS: The addition of atezolizumab to chemoradiation was not associated with a significant change in CMD in FACT-TOI at 15 months, with similar EQ-5D-5L and fatigue scores. While not randomized for RT-schedule, this analysis suggests that BID-RT (vs QD-RT) was associated with a consistently more favorable PRO trajectory.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.