Abstract
8076 Background: In the PACIFIC trial, 6.3% of patients with unresectable stage III NSCLC receiving durva after chemoRT developed CNSm. In a single center study, we previously reported real-world incidence of CNSm is higher at 19.8%. Risk factors for development of CNSm post-durva are incompletely understood. Methods: We conducted a multi-center retrospective study of patients with unresectable stage III NSCLC treated with durva after chemoRT from 2018 to 2022 with no CNSm on baseline brain MRI to assess for incidence of CNSm. Patient characteristics were compared between cohorts with and without CNSm to assess for risk factors for CNSm using Fisher’s exact test for categorical variables and two-sample t-test or Wilcoxon Mann-Whitney U-test for continuous variables. Overall survival was compared using log-rank test. Results: Of 193 patients in our study, 32 (16.6%) developed CNSm with median time to CNSm of 6.4 mo (IQR 4.5 - 13.7). Twenty-five (78%) had CNSm within one year. Patients with CNSm had a longer interval between baseline brain MRI and start of durva (median 3.7 mo vs 3.3 mo, p=0.02) and received fewer doses of durva compared to those without CNSm (median 7 vs 12, p=0.03). As some patients received Q2 week and others Q4 week durva, we also compared median durva treatment duration, which was consistent (3.7 mo vs 8.3 mo, p=0.02). There was no association between CNSm and age, sex, histology, T/N stage, PDL1 status, or chemoRT regimen (Table). Patients with CNSm had shorter median survival (19.6 mo vs 36.4 mo, p=0.008). Conclusions: Real-world incidence of CNSm is higher than that seen in PACIFIC. Patients with CNSm received less durva, likely due to early disease progression, and had longer intervals between baseline brain MRI and starting durva. Minimizing treatment delays may improve outcomes. Further research is needed to understand optimal surveillance strategies for CNSm in this patient population. [Table: see text]
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