A Real-World, Multicenter, Observational Retrospective Study of Durvalumab After Concomitant or Sequential Chemoradiation for Unresectable Stage III Non-Small Cell Lung Cancer

Frontiers in Oncology

Matteo Sepulcri¹  Marco Trovò²  Valerio Nardone³  Elisabetta Lattanzi⁴  Said Bou Selman⁵  Federica Bertolini⁶  Davide Franceschini⁷  Francesco Agustoni⁸  Barbara Alicja Jereczek-Fossa⁹  Andrea Riccardo Filippi^1,10  Niccolò Giaj Levra^1,11  Lorenzo Livi^1,12  Vieri Scotti^1,12  Alessandra Fozza^1,13  Stefano Vagge^1,13  Gaia Piperno^1,14  Valentina Vanoni^1,15  Maria Taraborrelli^1,16  Paolo Borghetti^1,17  Stefano Maria Magrini^1,17  Salvatore Cozzi^1,18  Alessio Bruni^1,19  Frank Lohr^1,19  Elisa D’Angelo^1,19 

[1] 0Radiation Oncology Unit, Veneto Institute of Oncology Istituto Oncologico Veneto (IOV), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy;1Radiation Oncology Department, Azienda Sanitaria Universitaria Integrata, Udine, Italy;2Radiotherapy Unit, “Ospedale del Mare”, Naples, Italy;3Radiotherapy Unit, University Hospital of Parma, Parma, Italy;4Department of Radiotherapy, Bolzano Hospital, Bolzano, Italy;5Medical Oncology Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy;6Department of Radiotherapy and Radiosurgery, Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)–Humanitas Research Hospital, Milan, Italy;7Medical Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy;8Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy;9Department of Radiation Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo and University of Pavia, Pavia, Italy;Advanced Radiation Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Sacro Cuore Don Calabria Hospital, Verona, Italy;Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy;Department of Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Martino, Genova, Italy;Division of Radiotherapy, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) European Institute of Oncology, Milan, Italy;Radiation Oncology Department, S. Chiara Hospital, Trento, Italy;Radiation Oncology Department, SS. Annunziata Hospital, “G. D’Annunzio” University of Chieti, Chieti, Italy;Radiation Oncology Department, Spedali Civili and University of Brescia, Brescia, Italy;Radiation Therapy Department, Arcispedale di Santa Maria Nuova IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Reggio Emilia, Italy;Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy;

关键词: chemoradiotherapy;    immunotherapy;    stage III;    unresectable;    NSCLC;   

DOI  :  10.3389/fonc.2021.744956

来源: DOAJ

【 摘 要 】

IntroductionFor unresectable stage III non-small cell lung cancer (NSCLC), the standard therapy consists of chemoradiotherapy (CRT) followed by durvalumab maintenance for responding patients. The present study reports on the safety and outcome of durvalumab use after CRT in a real-world, multicenter, retrospective cohort.MethodsTwo hundred thirty-eight patients have been included. We collected data on systemic therapy, radiation therapy, the timing between CRT and durvalumab, number of durvalumab cycles, reasons for non-starting or discontinuation, incidence and grade of adverse events (AEs), and progression-free survival (PFS) and overall survival (OS).ResultsOne hundred fifty-five patients out of 238 (65.1%) received at least one durvalumab dose: 91 (58.7%) after concomitant CRT (cCRT) and 64 (41.3%) after sequential CRT (sCRT). Programmed-death ligand 1 (PD-L1) status was unknown in 7/155 (4.5%), negative in 14 (9.1%), and positive ≥1% in 134/155 (86.4%). The main reasons for non-starting durvalumab were progression (10.1%), PD-L1 negativity (7.5%), and lung toxicity (4.6%). Median follow-up time was 14 months (range 2–29); 1-year PFS and OS were 65.5% (95%CI: 57.6-74.4) and 87.9% (95%CI: 82.26.6-93.9), respectively. No significant differences in PFS or OS were detected for cCRT vs. sCRT, but the median PFS was 13.5 months for sCRT vs. 23 months for cCRT. Potentially immune-related AEs were recorded in 76/155 patients (49.0%). Pneumonitis was the most frequent, leading to discontinuation in 11/155 patients (7.1%).ConclusionsDurvalumab maintenenace after concurrent or sequential chemoradiation for unresectable, stage III NSCLC showed very promising short-term survival results in a large, multicenter, restrospective, real-world study. Durvalumab was the first drug obtaining a survival benefit over CRT within the past two decades, and the present study contributes to validating its use in clinical practice.

【 授权许可】

Unknown