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Claire Griffiths
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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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P21.08 - Durvalumab Consolidation Following Chemoradiation for Unresectable Non-Small Cell Lung Cancer: A “Real-World” Experience. (ID 2077)
00:00 - 00:00 | Presenting Author(s): Claire Griffiths
- Abstract
Introduction
Durvalumab consolidation following chemoradiation for unresectable stage III NSCLC dramatically improved overall survival compared with placebo, and durvalumab consolidation is now considered the standard-of-care for this patient population. However, the trial enrolled patients following chemoradiation, perhaps allowing for selection of a healthier population with better prognostic factors than is encountered in the general population. Our group sought to describe the patient characteristics, efficacy and toxicity of consolidative durvalumab use in a “real-world” cohort.
Methods
We retrospectively identified patients with unresectable NSCLC who received durvalumab between 2018 and 2019 at our academic center and its community affiliates. Data was abstracted through electronic medical records. Descriptive stastics of patient-, disease-, and treatment-related variables were generated. Progression-free survival (PFS) and overall survival (OS) data was generated utilizing the Kaplan-Meier method.
Results
A total of 48 patients received durvalumab consolidation at our organization between 2018 and 2019. Median age of the cohort was 66 years old. Most patients (51%) had ECOG PS 1 but 21% were PS 2-3. While most patient were Caucasian (85%), African Americans accounted for 15% of the study sample. The dominant histologic subtype was squamous cell carcinoma (66%). PD-L1 was measured in 25 patients, with TPS > 50% in 44% of patients. Most patients (79%) had unresectable stage III disease (46% IIIA, 21% IIIB, 12% IIIC). Unresectable stage II accounted for 17% of patients and 4% received durvalumab following chemoradiation for oligometastatic NSCLC. Nearly all (91%) received weekly carboplatin and paclitaxel as radiosensitizing chemotherapy. Best overall response rate from chemoradiation and durvalumab was complete response (CR) in 8%, partial response (PR) in 69%, stable disease (SD) in 19% and progressive disease (PD) in 4%. Radiation pneumonitis occurred in 17% of the cohort with an 8% incidence of grade 3-5 radiation pneumonitis. At least one immune-related adverse event (irAE) occurred in 54% of the cohort, with 29% experiencing a grade 3-5 irAE. Pneumonitis was the most common irAE, experienced in 25% of the cohort (17% grade 3-5). Only 24% of patients completed the full 12-month course of durvalumab, with disease progression as the most common reason for discontinuation (48%). Both median PFS and OS have not been reached and will be updated at the time of the meeting.
Conclusion
This analysis highlights the inherent difficulties in generalizing clinical trial data to clinical practice. While this retrospective study had a small sample size, compared with the PACIFIC trial, it demonstrated striking challenges in completing the full 12-month durvalumab consolidation period, owing largely to disease progression and irAEs. The lower efficacy of durvalumab in our cohort may have been driven by poorer functional status and higher incidence of squamous cell carcinoma histology compared with the PACIFIC trial. Generation of larger “real world” samples for analysis through multi-institutional collaboration would be useful to help understand the efficacy of consolidative durvalumab, particularly as it relates to locoregional differences in patient and disease demographics.
