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- Title
Patterns and Incidence of Pneumonitis and Initial Treatment Outcomes with Durvalumab Consolidation Therapy after Radical Chemoradiotherapy for Stage III Non-Small Cell Lung Cancer.
- Authors
Sato, Mizuki; Odagiri, Kazumasa; Tabuchi, Yuya; Okamoto, Hiroaki; Shimokawa, Tsuneo; Nakamura, Yukiko; Hata, Masaharu
- Abstract
Simple Summary: Definitive concurrent chemoradiation therapy (CCRT) is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC), and durvalumab consolidation therapy after CCRT is now available following the results of the PACIFIC trial. However, its real-world clinical efficacy and impact on pneumonitis as a side effect have not been fully tested. In a retrospective analysis of 150 stage III NSCLC patients (durvalumab, n = 69; no-durvalumab, n = 81) who underwent CCRT at our institution, we found better progression-free survival and a higher incidence of pneumonitis grade ≥ 2 (G2) spreading beyond the irradiated fields in the durvalumab consolidation group than in the no-durvalumab group, but no change in ≥G3 severe pneumonitis. VS5 (lung volume spared from 5 Gy) was identified as a risk factor for pneumonitis ≥ G2 within the irradiated field in patients treated with durvalumab consolidation therapy. These results strongly encourage the use of durvalumab consolidation therapy in clinical practice. Durvalumab consolidation after chemoradiotherapy for stage III non-small cell lung cancer (NSCLC) has become the standard of care. Single-center results were examined for treatment outcomes and patterns of pneumonitis in clinical practice. Patients with stage III NSCLC who underwent chemoradiotherapy at our institution (n = 150) were included. The patients were treated with chemoradiotherapy and durvalumab consolidation (Group D, n = 69) or chemoradiotherapy alone (Group N, n = 81). The overall survival (OS), progression-free survival (PFS), and the incidence of and risk factors for 12-month pneumonitis grade ≥ 2 (G2) were investigated. Two-year OS rates were 71.6% in Group D and 52.7% in Group N (p = 0.052). Two-year PFS rates were 43.0% in Group D and 26.5% in Group N (p = 0.010), although a propensity score matched analysis showed no significant difference. The incidence of 12-month pneumonitis ≥ G2 tended to be higher in Group D than in Group N (41.9% vs. 26.3%, p = 0.080). However, there was no difference in pneumonitis ≥ G3 rates (10.5% vs. 12.6%, p = 0.657). A multivariate analysis showed that the lung volume spared from 5 Gy (VS5) < 1800 cm3 was a risk factor for pneumonitis ≥ G2 in Group D. Durvalumab consolidation showed the potential to prolong PFS without increasing the severity of pneumonitis.
- Subjects
RISK factors of pneumonia; THERAPEUTIC use of monoclonal antibodies; RISK assessment; RADIATION pneumonitis; TREATMENT effectiveness; DESCRIPTIVE statistics; CHEMORADIOTHERAPY; MULTIVARIATE analysis; CANCER chemotherapy; IMMUNE checkpoint inhibitors; LUNG volume measurements; LUNG cancer; TUMOR classification; CONSOLIDATION chemotherapy; PROGRESSION-free survival; OVERALL survival; EVALUATION
- Publication
Cancers, 2024, Vol 16, Issue 6, p1162
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16061162