Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Cancer Med. 2020 Jul;9(13):4622-4631. doi: 10.1002/cam4.3113. Epub 2020 May 6.
Durvalumab after concurrent chemoradiation (cCRT) is now standard of care for unresected stage III non-small cell lung cancer (NSCLC). However, there is limited data on radiation pneumonitis (RP) with this regimen. Therefore, we assessed RP and evaluated previously validated toxicity models in predicting for RP in patients treated with cCRT and durvalumab.
Patients treated with cCRT and ≥ 1 dose of durvalumab were evaluated to identify cases of ≥ grade 2 RP. The validity of previously published RP models was assessed in this cohort as well a reference cohort treated with cCRT alone. The timing and incidence of RP was compared between cohorts.
In total, 11 (18%) of the 62 patients who received cCRT and durvalumab developed ≥ grade 2 RP a median of 3.4 months after cCRT. The onset of RP among patients treated with cCRT and durvalumab was significantly longer vs the reference cohort (3.4 vs 2.1 months; P = .01). Numerically more patients treated with cCRT and durvalumab developed RP than patients in the reference cohort (18% vs 9%, P = .09). Among patients treated with cCRT and durvalumab, 82% (n = 9) were responsive to treatment with high-dose glucocorticoids. Previously published RP models widely underestimated the rate of RP in patients treated with cCRT and durvalumab [AUC ~ 0.50; p(Hosmer-Lemeshow): 0.98-1.00].
Our data suggest a delayed onset of RP in patients treated with cCRT and durvalumab vs cCRT alone, and for RP to develop in a greater number of patients treated with cCRT and durvalumab. Previously published RP models significantly underestimate the rate of symptomatic RP among patients treated with cCRT and durvalumab.
对于未切除的 III 期非小细胞肺癌（NSCLC），durvalumab 联合同期放化疗（cCRT）现在是标准治疗方案。然而，关于该方案的放射性肺炎（RP）数据有限。因此，我们评估了该方案治疗后 RP 的发生情况，并对接受 cCRT 和 durvalumab 治疗的患者的 RP 进行了先前验证的毒性模型评估。
评估了接受 cCRT 和至少一剂 durvalumab 治疗的患者，以确定是否发生≥2 级 RP。该队列还评估了先前发表的 RP 模型的有效性，以及单独接受 cCRT 治疗的参考队列。比较了两个队列中 RP 的发生时间和发生率。
在接受 cCRT 和 durvalumab 治疗的 62 例患者中，共有 11 例（18%）发生≥2 级 RP，中位时间为 cCRT 后 3.4 个月。与参考队列相比（3.4 与 2.1 个月；P=0.01），接受 cCRT 和 durvalumab 治疗的患者 RP 发病时间明显更长。与参考队列相比（18%与 9%；P=0.09），接受 cCRT 和 durvalumab 治疗的患者中发生 RP 的患者更多。在接受 cCRT 和 durvalumab 治疗的患者中，82%（n=9）对高剂量糖皮质激素治疗有反应。先前发表的 RP 模型广泛低估了接受 cCRT 和 durvalumab 治疗的患者的 RP 发生率（AUC~0.50；p（Hosmer-Lemeshow）：0.98-1.00）。
与单独接受 cCRT 相比，接受 cCRT 和 durvalumab 治疗的患者发生 RP 的时间更晚，且接受 cCRT 和 durvalumab 治疗的患者发生 RP 的患者更多。先前发表的 RP 模型显著低估了接受 cCRT 和 durvalumab 治疗的患者中出现症状性 RP 的发生率。
