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Shelley Kuang
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P21 - Locoregional and Oligometastatic Disease - Treatment of Locally Advanced NSCLC (ID 131)
- Event: WCLC 2020
- Type: Posters
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P21.05 - Overall Survival by PD-L1 Status in Stage III NSCLC Following Implementation of Durvalumab: The Real-World Application of PACIFIC (ID 1624)
00:00 - 00:00 | Presenting Author(s): Shelley Kuang
- Abstract
Introduction
In patients with unresectable stage III NSCLC, consolidative durvalumab has been shown to improve both PFS and OS following concurrent chemoradiotherapy. We performed a retrospective review to better understand patient outcomes by PD-L1 status in British Columbia.
Methods
A review of unresectable stage III NSCLC patients treated with chemoradiotherapy between March 2018 and June 2019 was conducted, after durvalumab was provincially available. Patient demographics, histology, stage, ECOG, smoking status, PD-L1 status if measured, sites of disease progression, and treatment toxicity were collected.
Results
196 patients were identified. Baseline characteristics were median age 67, female 49%, 69% non-squamous, 31% squamous histology. Median radiotherapy dose was 60 Gy, 38% received cisplatin, 62% carboplatin. 17% (n=34) PD-L1 <1%; 13% (n=25) PD-L1 1-49%; 23% (n=46) PD-L1 ≥50%; 46% (n=91) PD-L1 unknown. 49% (n=97) received durvalumab, with 47% (n=16) PD-L1 <1%; 36% (n=9) PD-L1 1-49%; 46% (n=21) PD-L1 ≥50%; 56% (n=51) PD-L1 unknown. Median time to starting durvalumab after chemoradiotherapy was 43 days, median treatment completed was 18 cycles, 22 patients remain on durvalumab. Within 6 weeks of completing concurrent chemoradiotherapy, 13% of patients progressed, 4% of patients died. Median follow-up was 18.2 months. Death on durvalumab vs surveillance was 29% vs 53% in PD-L1 <1%, 42% vs 63% in PD-L1 1-49%, 10% vs 42% in PD-L1≥50%, 17% vs 42% in PD-L1 unknown. The 1-year OS on durvalumab vs surveillance was 65% vs 47% in PD-L1 <1% (p=0.345), 53% vs 49% in PD-L1 1-49% (p=0.392), 95% vs 72% in PD-L1≥50% (p=0.039), and 88% vs 76% in PD-L1 unknown (p=0.023).
Conclusion
In a real-world population, durvalumab was associated with higher OS in patients with unresectable stage III NSCLC following concurrent chemoradiotherapy. There was a trend for improved overall survival in patients with high expression of PD-L1 (≥50%) from durvalumab after chemoradiotherapy, with 1-year OS 95% vs 72% (p=0.039). Durvalumab was not detrimental in patients with no expression or low expression of PD-L1, and further studies are needed to evaluate its benefit. Based on these findings, PD-L1 expression may be a useful biomarker to predict efficacy, and patients should not be excluded from receiving durvalumab after chemoradiotherapy based on PD-L1 status.
