Pulmonary toxicities after chemoradiation followed by durvalumab for stage III NSCLC: a real setting

ABSTRACT

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). Materials 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