Does immunotherapy improve outcomes for patients treated with SBRT for early stage lung cancer? SWOG/NRG S1914 was a phase 3 trial that sought to determine if induction and consolidative atezolizumab improved overall survival in patients with high risk, early stage NSCLC. It included 402 patients with T1-3N0 disease measuring 7 cm or less, and high risk features included tumor size 2 cm or greater, FDG PET SUV max 6.2 or higher, and moderate or poor differentiation. Those randomized to immunotherapy received a total of 8 cycles of atezolizumab every 3 weeks with SBRT delivered during cycle 3. At 2 years, there was no difference in OS, which was 82% in both arms. Grade 3+ adverse events were higher with atezolizumab (12% v 3%), and there were two deaths in the atezo group. This trials questions the overall benefit of atezolizumab with SBRT, but also whether sequencing before SBRT may be counterproductive. | Daly, Lancet 2026
