BACE Added to Tislelizumab Improved Response in Bulky NSCLC

Key Takeaways

• In inoperable, driver-negative stage IIIB-IVB non-small cell lung cancer (NSCLC) with primary tumors at least 50 mm, a first-line sequential bronchial arterial chemoembolization (BACE)-containing regimen with tislelizumab was associated with higher response than tislelizumab plus chemotherapy alone.
• Progression-free survival (PFS) was longer with the sequential regimen.
• Median overall survival (OS) was numerically longer with the sequential regimen but was not significantly different between groups.
• Grade 3 or higher hematologic toxicities occurred at broadly comparable numerical rates across groups, and BACE-related chest pain and transient cough were infrequent and low grade.
• Multivariable analysis identified treatment regimen and baseline tumor diameter as significant predictors of PFS.

Bulky primary tumors remain a difficult subset within advanced non-small cell lung cancer because high intrathoracic tumor burden can complicate early disease control even when immunotherapy-based treatment is used first line. Whether a locoregional debulking step before standard tislelizumab-based therapy improves first-line outcomes in inoperable, driver-negative stage IIIB-IVB disease with tumors measuring at least 50 mm remains uncertain. At Guiyang Public Health Clinical Center in China, clinicians compared those strategies in patients with this bulky-disease profile.

At Guiyang Public Health Clinical Center in China, the Quan et al cohort study of sequential tislelizumab plus bronchial arterial chemoembolization in bulky advanced NSCLC retrospectively compared prospectively collected data from January 2022 through April 2025 in 68 adults aged 18 to 75 years with newly diagnosed, pathologically confirmed, inoperable, driver-negative American Joint Committee on Cancer (AJCC) 8th edition stage IIIB-IVB NSCLC and bulky primary tumors defined as maximum diameter at least 50 mm. Group A received BACE, tislelizumab one day later, then after 3 weeks 4 to 6 cycles of platinum-based chemotherapy plus tislelizumab followed by maintenance tislelizumab, while Group B started tislelizumab plus platinum-based chemotherapy on the same day and then continued maintenance tislelizumab. Assignment was nonrandomized and made by multidisciplinary tumor board consensus according to tumor anatomical suitability for BACE, tolerance for sequential therapy, and patient preference. Response was assessed with Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1), adverse events with Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0), primary endpoints were objective response rate (ORR) and disease control rate (DCR), and secondary endpoints were PFS, OS, and safety.

Baseline characteristics did not differ significantly between groups. ORR was 79% (27/34) with sequential tislelizumab plus BACE plus chemotherapy versus 44% (15/34) with tislelizumab plus chemotherapy alone (p=0.006). Median PFS was 12.47 versus 7.73 months, with HR 0.55, 95% CI 0.30-0.99; p=0.024. Disease control was high in both groups, and no complete responses were reported.

Median follow-up was 16.82 months in Group A and 14.72 months in Group B. Median OS was 20.73 versus 19.63 months, with HR 0.64, 95% CI 0.31-1.31; p=0.071. In multivariable Cox analysis, treatment regimen and tumor diameter were significant predictors of PFS, reported as HR 2.1 (95% CI 1.13-3.904; p=0.019) and HR 2.263 (95% CI 1.077-4.755; p=0.031), respectively. The authors interpreted these findings as favoring the Group A regimen and smaller baseline tumor diameter, although the reported reference coding should be considered when interpreting HR direction. Grade 3 or higher hematologic treatment-related adverse events occurred at broadly comparable numerical rates overall, while BACE-related chest pain in 1 patient (3%) and transient cough in 4 patients (12%) were infrequent and all grade 1.

Because the comparison came from a retrospective, single-center, nonrandomized cohort with tumor-board allocation, the findings support association rather than causal inference. The authors also noted the small sample, relatively short follow-up that leaves OS preliminary, incomplete programmed death-ligand 1 (PD-L1) data, and the absence of quality-of-life assessment. For U.S. and Canadian clinicians, the signal is best viewed as hypothesis-generating because the evidence comes from a single Chinese center using a BACE-capable care pathway. That context narrows how far the response and PFS advantages can be extended, especially in the setting of no statistically significant OS difference.

According to the authors, sequential tislelizumab plus BACE followed by systemic chemotherapy in this cohort of bulky advanced NSCLC was associated with favorable response and longer PFS with manageable safety, and treatment regimen together with baseline tumor diameter were reported as useful PFS predictors. This conclusion remains specific to patients with inoperable, driver-negative stage IIIB-IVB disease and large primary tumors treated in this setting.

Clinician Questions

Which patients with advanced NSCLC do these bulky-tumor tislelizumab-BACE results apply to?

These results apply to adults aged 18 to 75 years with newly diagnosed, pathologically confirmed, inoperable, driver-negative AJCC 8th edition stage IIIB-IVB NSCLC and a primary tumor maximum diameter of at least 50 mm who received first-line treatment at a single center in China. The cohort does not directly address outcomes for smaller primary tumors, operable disease, or driver-positive tumors because those groups were not included.

How was bronchial arterial chemoembolization sequenced with tislelizumab and chemotherapy in the bulky NSCLC cohort?

Group A received BACE first, tislelizumab 200 mg one day later, then after three weeks 4 to 6 cycles of platinum-based chemotherapy plus tislelizumab, followed by maintenance tislelizumab until progression or intolerance. Group B started tislelizumab plus platinum-based chemotherapy on the same day and then continued maintenance tislelizumab.

How were patients assigned to the BACE-containing regimen rather than tislelizumab plus chemotherapy alone in bulky advanced NSCLC?

Patients were assigned nonrandomly by a standardized multidisciplinary tumor board according to tumor anatomical suitability for BACE, tolerance for sequential therapy, and patient preference. Because treatment selection was made this way rather than by random allocation, the comparison supports association rather than a causal conclusion.

Why was overall survival harder to interpret than progression-free survival in this bulky advanced NSCLC cohort? [h2] [/h2] Overall survival was harder to interpret because follow-up was still relatively short, so the authors described the OS results as preliminary. The authors also noted that treatments administered after disease progression could have influenced longer-term survival.