Patient-Reported Outcome Analysis of NRG Oncology Trial in Limited-Stage Small Cell Lung Cancer Suggests More Favorable Quality-of-Life Trajectory with Twice-Daily versus Once-Daily Radiation – Results Published

09/30/2025

PHILADELPHIA, PA – Previously, the primary endpoint results of the NRG-LU005 (NCT03811002) study assessing the addition of the immunotherapy drug atezolizumab (Tecentriq®) to standard of care concurrent chemoradiation for limited-stage small cell lung cancer were reported at the American Society for Radiation Oncology 2024 Annual Meeting. Those results showed that adding atezolizumab did not improve overall survival (OS) for this patient population.   At the same time, an exploratory analysis reported a longer median OS among patients who received twice-a-day radiation, though the RT schedule was not randomized. As a follow up to that study, a patient-reported outcomes (PRO) analysis explored the impact of the NRG-LU005 treatment regimens on quality of life (QOL). The results of this PRO analysis are now published in the Journal of Thoracic Oncology after previously being reported as a late-breaking abstract at the ASTRO 2025 Annual Meeting in San Francisco, California.

Although NRG-LU005 results did not meet its primary endpoint regarding OS, an incidental finding indicated that twice-daily radiation was associated with longer survival than once-daily radiation. While this study was not randomized between twice-daily and once-daily radiation, the NRG-LU005 PRO analysis also suggested less clinically meaningful decline in longer term QOL with twice daily (versus once daily) radiation in a sample cohort of participants who completed PRO surveys.

NRG-LU005 accrued and randomized 544 patients receiving standard chemoradiation with thoracic RT (either at 45Gy twice daily or 66Gy daily) to plus/minus concurrent and adjuvant immunotherapy. PROs included validated instruments: FACT-TOI, EQ-5D-5L, and PROMIS-Fatigue. Clinically meaningful decline (CMD) and longitudinal trends were also evaluated.

Among a cohort of trial participants who were alive and on-study at each assessment, PRO compliance for this analysis was high – exceeding 85% at baseline and stabilized at 60-68% through 21 months after completion of chemoradiation. Healthier patients with better performance scores and lung function were more likely to complete these surveys. FACT-TOI declined on both arms during chemoradiation as expected; however, this improved at 3 months and either remained stable or exceeded the baseline by 6-21 months following treatment. Fewer patients on the immunotherapy arm of NRG-LU005 experienced CMD (25% vs. 38%) in FACT-TOI at 21 months. However, this observation is influenced by the fact that those who completed the assessments tended to be healthier. Of note, while this study was not randomized between twice-daily and once-daily RT, approximately half of the patients received twice-daily radiation, and this was associated with a more favorable QOL trajectory over time than once-daily radiation.

The association remained multivariable analysis after adjusting for patient characteristics, but since the radiation schedule was not randomized, other factors may have contributed to the results. The QOL chair of this NRG-LU005 study was Dr. Benjamin Movsas, co-Medical Director of Henry Ford Cancer in Michigan and co-chair of the Henry Ford Health + Michigan State University Health Sciences Cancer Committee.

Research reported in this publication was supported by the National Cancer Institute (NCI), part of the National Institutes of Health under Award Number U10CA180868 (NRG Oncology Operations), U10CA180822 (NRG Oncology SDMC), UG1CA189867 (NCORP), U24CA196067 (NRG Specimen Bank), U24CA180803 (IROC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This project was also supported by Genentech, a member of the Roche Group under a Cooperative Research and Development Agreement with National Cancer Institute. NRG-LU005 is NCI sponsored, led by NRG Oncology and conducted by the NCI funded National Clinical Trials Network (NCTN).

Tecentriq® (atezolizumab) is a registered trademark of Genentech, a member of the Roche Group.  

Citation
Movsas B, Hu C, Higgins KA, Ross HJ, Jabbour SK, Kozono D, Owonikoko TK, Xiao C, Shoji T, Faller BA, Mohindra P, Dib EG, Brownstein J, Chun SG, Kuzma CS, Kotecha R, Onitilo A, Mulford D, Paulus R, Bradley JD, Bruner DW. Comprehensive Patient Reported Outcomes (PROs) from NRG Oncology/Alliance LU005: A Randomized Trial Of Chemoradiation +/- Atezolizumab In Limited-Stage Small Cell Lung Cancer. J Thorac Oncol. 2026 Jul 30:104117. doi: 10.1016/j.jtho.2026.104117. Epub ahead of print. PMID: 42532339. PubMed Link

Movsas B, Hu C, Higgins KA, Ross HJ, Jabbour SK, Kozono DE, Owonikoko TK, Xiao C, Shoji T, Faller BA, Mohindra P, Dib EG, Brownstein JM, Chun SG, Kuzma CS, Kotecha RR, Onitilo AA, Paulus R, Bradley JD, Bruner DW. Comprehensive Patient Reported Outcomes (PROs) from NRG LU005: A Randomized Trial Of Chemoradiation (CRT) +/- Atezolizumab In Limited-Stage Small Cell Lung Cancer (LS-SCLC). Paper presented during the Late Breaking Abstract Session at the annual meeting of the American Society for Radiation Oncology. San Francisco, CA. (2025, September-October).

About NRG Oncology
NRG Oncology conducts practice-changing, multi-institutional clinical and translational research to improve the lives of patients with cancer. Founded in 2012, NRG Oncology is a Pennsylvania-based nonprofit corporation that integrates the research of the legacy National Surgical Adjuvant Breast and Bowel Project (NSABP), Radiation Therapy Oncology Group (RTOG), and Gynecologic Oncology Group (GOG) programs. The research network seeks to carry out clinical trials with emphasis on sex-specific malignancies, including gynecologic, breast, and prostate cancers, and on localized or locally advanced cancers of all types. NRG Oncology’s extensive research organization comprises multidisciplinary investigators, including medical oncologists, radiation oncologists, surgeons, physicists, pathologists, and statisticians, and encompasses more than 1,300 research sites located world-wide with predominance in the United States and Canada. NRG Oncology is supported primarily through grants from the National Cancer Institute (NCI) and is one of five research groups in the NCI’s National Clinical Trials Network. www.nrgoncology.org