Abstract
SummaryIntroduction Durvalumab has been shown to confer a survival benefit after definitive chemoradiotherapy in the patients with locally advanced non-small cell lung cancer, but no studies have attempted to identify risk factors for pneumonitis after durvalumab therapy. The purpose of this study was to investigate associations between clinical and radiation dose-volume factors, and the severity of pneumonitis. Methods We retrospectively assessed the cases of 30 patients who had been started on durvalumab therapy between July 2018 and February 2019. In this study we evaluated the percentage of lung volume receiving radiation dose in excess of 20 Gy (V20) as radiation dose-volume factor. We compared V20 and some baseline factors between a grade 0 or 1 (Gr 0/1) pneumonitis group and a grade 2 or more (≥Gr 2) pneumonitis group, and we performed a logistic regression analysis to establish the associations between variables and ≥ Gr 2 pneumonitis. Results Pneumonitis had developed in 22 patients (73.3%): Gr 1/2/3–5 in 8 (26.7%)/14 (46.7%) /0 (0%), respectively. The difference in V20 between the Gr 0/1 group and Gr 2 group (median: 20.5% vs. 23.5%, p = 0.505) was not statistically significant, and thus V20 was not a risk factor for Gr 2 pneumonitis (odds ratio: 1.047, p = 0.303). None of the clinical factors, including sex, age, smoking history, presence of baseline pneumonitis, type of radiation therapy, location of lesion and facility, were risk factors. Conclusions Our study suggest that the severity of pneumonitis after durvalumab is unrelated to V20 or any of the clinical factors assessed in this study.
Highlights
Definitive concurrent chemoradiotherapy (CRT) is a standard treatment for unresectable locally advanced non-small cell lung carcinoma (NSCLC)
A metaanalysis reported that the incidence of radiation pneumonitis is 5%–50% rate, and that the mortality rate is 1%–2% [8], but it is unknown whether combining immune checkpoint inhibitors (ICIs) therapy with CRT increases the risk of pneumonitis
Twenty-one patients were treated with threedimensional conformal radiation, and two patients were treated with intensity modulated radiation therapy (IMRT)
Summary
Definitive concurrent chemoradiotherapy (CRT) is a standard treatment for unresectable locally advanced non-small cell lung carcinoma (NSCLC). Japan 4 Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan radiation therapy synergistically enhances the antitumor effects of immunotherapy, such as with immune checkpoint inhibitors (ICIs), by increasing tumor infiltration and upregulating PD-L1 expression [1, 2]. Durvalumab has been shown to confer a survival benefit after definitive CRT in patients with locally advanced NSCLC in the PACIFIC trial [6, 7]. A metaanalysis reported that the incidence of radiation pneumonitis is 5%–50% rate, and that the mortality rate is 1%–2% [8], but it is unknown whether combining ICI therapy with CRT increases the risk of pneumonitis. The incidence of any grade (Gr) pneumonitis in the durvalumab arm of the PACIFIC trial
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