Virtual Library
Start Your Search
Fiona Mienko
Author of
-
+
P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
-
+
P2.18-11 - Real-World Experience of Consolidation Durvalumab for Locally Advanced Non-Small Cell Lung Cancer (NSCLC) (ID 1895)
10:15 - 18:15 | Author(s): Fiona Mienko
- Abstract
Background
Durvalumab was recently approved as consolidation treatment following concurrent chemoradiation (CRT) in stage III NSCLC based on the positive PACIFIC trial demonstrating improved progression free survival (PFS) and overall survival (OS). Here, we examined the integration of durvalumab therapy after CRT in an urban comprehensive cancer care center serving a high proportion of Black and Hispanic patients. We aimed to examine treatment barriers in this diverse patient population and gain insights into real-world experience.
Method
Our study included patients treated with CRT for NSCLC (stage II-III) at Montefiore Medical Center (MMC) from 2007-2018. Retrospective analysis was conducted to evaluate patient characteristics, therapies and outcomes. Patients were grouped based on the PACIFIC trial eligibility criteria for durvalumab. PFS and OS were estimated using the Kaplan-Meier method, and comparisons between subgroups were made using log-rank testing, adjusted by Cox proportional hazards regression.
Result
146 patients completed CRT for locally advanced NSCLC from 2007 to 2018. 27% (n=40) would be considered ineligible for durvalumab based on the PACIFIC criteria (Table 1: reasons). Patient demographics were similar in ineligible vs. eligible groups: mean age 67.7 vs 67.9 years, male 57.6% vs 43.5%, Black 36.7% vs 43.5%, Hispanic 22.6% vs 30.1%. In the era of durvalumab therapy (since 9/2017), 68% (n=17) received durvalumab, including 4 patients that did not meet PACIFIC criteria due to co-morbidities and/or additional malignancy. The use of durvalumab therapy has increased with time in eligible patients from 33% in 9/2017-12/2017 to 100% in 10/2018-12/2018. The median time to initiate durvalumab following CRT has decreased from 56 days before 7/2018 to 30 days afterwards (p=0.02). Several eligible patients did not receive durvalumab due to questionable benefit in EGFR–mutant NSCLC (n=2), refusal of treatment (n=1), and unkown (n=1). Compared to patients who received durvalumab, patients who did not receive it were found to be of a lower socioeconomic status (p=0.086). Moreover, there was a trend toward improved 15-month OS rates in durvalumab-treated patients compared with patients who did not receive it (100% vs 87.5%, p=0.131).
Table 1: Reasons for ineligibility based on PACIFIC criteria for durvalumab consolidation treatment Reasons for ineligibility N (%) Severe concurrent illness 13 (32%) Additional malignancy other than NSCLC 6 (15%) Not stage III 5 (12%) Progression after chemoRT 3 (7%) Persisting Grade 3 toxicity related to chemoRT 3 (7%) Incomplete chemoRT 2 (5%) Autoimmune disease 2 (5%) Recieved alternate study 2 (5%) Lost to follow up 2 (5%) Mixed small cell histology 1 (2%) Unknown 1 (2%)
Conclusion
Our results reveal more frequent use and improved time to initiate durvalumab following CRT, as well as promising initial survival data in a real world setting. A substantial proportion of patients would be ineligible as per PACIFIC criteria, yet several received durvalumab and remain disease controlled, suggesting that further investigation of durvalumab in this population is warranted.
