Prognostic impact of pneumonitis after durvalumab therapy in patients with locally advanced non-small cell lung cancer

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.

Efficacy and safety of consolidation durvalumab after chemoradiation therapy for stage III non-small-cell lung cancer: a systematic review, meta-analysis, and meta-regression of real-world studies

“…In the PACIFIC trial ( Antonia et al, 2017 ), the median age of patients was 64 years while in most of the real-world included studies the median age was higher than 64. In the studies of Sankar et al (2022) , Tsukita et al (2021) Nishimura et al (2022) , and LeClair et al (2022) , the median age the highest, at 69, 70, 69.5, and 69.8 years, respectively. This age range is much more reflective of the actual age of NSCLC patients in actual clinical practice.…”

“…Of them, 67 articles were selected for a full-text review and 41 were then excluded due to different reasons. Finally, a total of 26 articles corresponding to 23 studies were included in the review ( Girard et al, 2019 ; Girard et al, 2020 ; Girard et al, 2021 ; Faehling et al, 2020 ; Jain et al, 2020 ; Jegannathen, 2020 ; Jung et al, 2020 ; Miura et al, 2020 ; Noronha et al, 2020 ; Offin et al, 2020 ; Bruni et al, 2021 ; Desilets et al, 2021 ; Jazieh et al, 2021 ; Kartolo et al, 2021 ; Landman et al, 2021 ; Lau et al, 2021 ; McDonald et al, 2021 ; Taugner et al, 2021 ; Tsukita et al, 2021 ; Vrankar et al, 2021 ; Wang et al, 2021 ; Avrillon et al, 2022 ; LeClair et al, 2022 ; Nishimura et al, 2022 ; Riudavets et al, 2022 ; Sankar et al, 2022 ).…”

Durvalumab-Associated Pneumonitis in Patients with Locally Advanced Non-Small Cell Lung Cancer: A Real-World Population Study

“…Severe (grade ≥ 3) pneumonitis was also more frequent in our cohort (9% versus 2.7%). There seems to be a large range of pneumonitis rates post durvalumab in the current literature, from 22 to 81% (Supplementary Table S1) [7][8][9][10][11][12][13][14][15][16][17]. A recent meta-analysis by Wang et al also demonstrated this large range of incidences (22-48%) [18].…”