Abstract
SummaryBackground. Prognostic data on Japanese patients receiving durvalumab after chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer (LA-NSCLC) are insufficient. Whether pneumonitis has prognostic implications in patients with LA-NSCLC who have received durvalumab also remains unclear. Methods. We retrospectively assessed the data of 82 consecutive patients who had received durvalumab after CRT at our institution between May 2018 and August 2020. A multi-state model was used to establish the associations between co-variables and progression-free survival (PFS). Results. The median observation period for all the censored cases was 14.5 months (5.7–28.9 months), the median PFS was 22.7 months, and the 12-month PFS rate was 62.3% (95% CI: 50.2%-72.3%). The median percentage of the lung volume receiving a radiation dose in excess of 20 Gray (V20) was 22% (4%-35%). Thirteen patients (16%) had Grade 1 pneumonitis before receiving durvalumab, and 62 patients developed pneumonitis after durvalumab (Grades 1, 2, and 3 in 25 [30%], 32 [39%], and 4 [5%], respectively). Twenty-four patients (29%) completed the 1-year durvalumab treatment period, 16 patients (20%) were continuing to receive treatment, and 42 (51%) had discontinued treatment. In a multi-state analysis, patients with pneumonitis before durvalumab therapy had a poorer PFS than those without pneumonitis (HR: 4.29, p = 0.002). The development of Grade 2 or higher pneumonitis after durvalumab was not a significant prognostic factor for PFS (HR: 0.71, p = 0.852). Conclusion. Grade 2 or higher pneumonitis after durvalumab was not a prognostic factor of PFS in LA-NSCLC patients received durvalumab.
Highlights
The standard treatment for unresectable locally advanced non-small cell lung cancer (LA-NSCLC) is definitive chemoradiotherapy (CRT) with durvalumab
One-hundred and eight consecutive patients with stage III NSCLC after definitive CRT who were considered for durvalumab at our institution between April 2018 and January 2020, including 5 patients who were referred to our institution after CRT at other hospitals for durvalumab therapy
Fifty-five patients were treated with three-dimensional conformal radiation, and 14 patients were treated with intensity modulated radiation therapy (IMRT)
Summary
The standard treatment for unresectable locally advanced non-small cell lung cancer (LA-NSCLC) is definitive chemoradiotherapy (CRT) with durvalumab. Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan. Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan. In the PACIFIC trial, the incidence of any-grade pneumonitis was 33.9% in all patients and 73.6% in the Japanese subgroup [2]. Horinouchi et al reported an incidence of radiation pneumonitis after CRT of 72.9% among Japanese patients with Stage III NSCLC in a retrospective cohort study that was performed before durvalumab approval [3]. This incidence was similar to the incidence of pneumonitis in the Japanese subgroup of the PACIFIC study [3].
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