Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Hematology/Oncology, The University of Chicago, Chicago, Illinois.
Centre Hospitalier Universitaire, Université Paul Sabatier, Toulouse, France.
J Thorac Oncol. 2022 Dec;17(12):1415-1427. doi: 10.1016/j.jtho.2022.07.1148. Epub 2022 Aug 9.
INTRODUCTION: On the basis of the findings of the phase 3 PACIFIC trial (NCT02125461), durvalumab is standard of care for patients with stage III, unresectable NSCLC and no disease progression after concurrent chemoradiotherapy (cCRT). Many patients are considered unsuitable for cCRT owing to concerns with tolerability. The phase 2 PACIFIC-6 trial (NCT03693300) evaluates the safety and tolerability of durvalumab after sequential CRT (sCRT). METHODS: Patients with stage III, unresectable NSCLC and no progression after platinum-based sCRT were enrolled to receive durvalumab (1500 mg intravenously) every 4 weeks for up to 24 months. The primary end point was the incidence of grade 3 or 4 adverse events possibly related to treatment occurring within 6 months. Secondary end points included investigator-assessed progression-free survival (PFS; Response Evaluation Criteria in Solid Tumors version 1.1) and overall survival. RESULTS: Overall, 117 patients were enrolled (59.8% with performance status >0, 65.8% aged ≥65 y, and 37.6% with stage IIIA disease). Median treatment duration was 32.0 weeks; 37.6% of patients remained on treatment at data cutoff (July 15, 2021). Grade 3 or 4 AEs occurred in 18.8% of patients. Five patients had grade 3 or 4 possibly related adverse events within 6 months (incidence: 4.3%; 95% confidence interval: 1.4-9.7), including two pneumonitis cases. Two patients (1.7%) had grade 5 AEs of any cause. Survival data maturity was limited. Median PFS was 10.9 months (95% confidence interval: 7.3-15.6), and 12-month PFS and overall survival rates were 49.6% and 84.1%, respectively. CONCLUSIONS: Durvalumab after sCRT had a comparable safety profile with that observed with durvalumab after cCRT in PACIFIC and had encouraging preliminary efficacy in a frailer population.
简介:基于 III 期 PACIFIC 试验(NCT02125461)的结果,度伐利尤单抗是 III 期不可切除 NSCLC 患者的标准治疗方法,这些患者在接受同步放化疗(cCRT)后无疾病进展。由于对耐受性的担忧,许多患者被认为不适合 cCRT。II 期 PACIFIC-6 试验(NCT03693300)评估了序贯放化疗(sCRT)后度伐利尤单抗的安全性和耐受性。
方法:III 期不可切除 NSCLC 患者在铂类 sCRT 后进展,入组接受度伐利尤单抗(1500 mg 静脉注射)每 4 周 1 次,最多 24 个月。主要终点是 6 个月内发生的可能与治疗相关的 3 级或 4 级不良事件发生率。次要终点包括研究者评估的无进展生存期(PFS;实体瘤反应评价标准 1.1 版)和总生存期。
结果:共有 117 例患者入组(体力状态>0 占 59.8%,≥65 岁占 65.8%,III A 期占 37.6%)。中位治疗持续时间为 32.0 周;数据截止(2021 年 7 月 15 日)时,37.6%的患者仍在接受治疗。18.8%的患者发生 3 级或 4 级 AE。5 例患者在 6 个月内发生 3 级或 4 级可能与治疗相关的不良事件(发生率:4.3%;95%置信区间:1.4-9.7),包括 2 例肺炎。2 例患者(1.7%)发生任何原因的 5 级 AE。生存数据成熟度有限。中位 PFS 为 10.9 个月(95%置信区间:7.3-15.6),12 个月 PFS 和总生存率分别为 49.6%和 84.1%。
结论:sCRT 后使用度伐利尤单抗的安全性与 PACIFIC 中 cCRT 后使用度伐利尤单抗的安全性相当,在更脆弱的人群中具有令人鼓舞的初步疗效。
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