Pulmonary toxicities after chemoradiation followed by durvalumab for stage III NSCLC: a real setting
Constance Nicolet,
France
PO-1267
Abstract
Pulmonary toxicities after chemoradiation followed by durvalumab for stage III NSCLC: a real setting
Authors: Constance Nicolet1, Nathalie Briot2, Caroline Amoyal1, Cédric Chevalier1, Chloé-Line Jeandidier1, Courèche Kaderbhai3, Pascal Foucher4, Virginie Westeel5, Etienne Martin1
1Centre Georges François Leclerc, Radiotherapy, Dijon, France; 2Centre Georges François Leclerc, Statistical analysis department, Dijon, France; 3Centre Georges François Leclerc, Medical Oncology , Dijon, France; 4University Hospital Center François Mitterand, Thoracic Oncology, Dijon, France; 5University Hospital Center Jean Minjoz, Thoracic Oncology, Besançon, France
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Purpose or Objective
Evaluation of the incidence of pulmonary toxicities, especially pneumonitis, for patients treated in a real setting with concurrent chemoradiation (CRT) followed by adjuvant durvalumab for unresectable stage III non-small-cell lung cancer (NSCLC).
Material and Methods
This study included retrospectively 84 patients with unresectable stage III NSCLC treated by CRT followed by durvalumab in 5 french centers from May 2017 to May 2021. Pneumonitis incidence was analysed with a distinction between immune pneumonitis, lung infection and radiation pneumonitis. A multivariate analysis was realized for radiation pneumonitis to find predictive factors. Overall survival (OS) and Progression Free Survival (PFS) were also evaluated.
Results
With a median follow-up of 23 months, grade 3-4 pneumonitis were as follows: 3.4% of radiation pneumonitis, 5.9% of immune pneumonitis and 13.4% of lung infections. . In multivariate analysis, age ≥ 68 years-old, cardiovascular history and use of docetaxel came out as predictive factors for radiation pneumonitis.
Considering the entire population, median PFS was 28.9 months and the 2-year OS was 70.8%. Besides, among our population study, 31% of patients presented at least one or more exclusion or non-inclusion criteria according to initial PACIFIC protocol. But there was no difference between the patients who meet the PACIFIC criteria and the others, whether for toxicity or survivals.
The beginning of the durvalumab consolidation within 14 days after ending CRT seemed to improve the PFS according to PACIFIC’s findings.
Conclusion
In our real-word study, incidence of grade 3-4 radiation pneumonitis and immune pneumonitis are similar to those in the PACIFIC trial. Incidence of lung infections was higher, probably because of the context of SARS-CoV-2 pandemic. Age ≥ 68 years-old, cardiovascular history and use of docetaxel were found to be predictive factors for radiation pneumonitis. Moreover, PFS and OS were excellent.