Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Radiother Oncol. 2023 Mar;180:109454. doi: 10.1016/j.radonc.2022.109454. Epub 2023 Jan 11.
Concurrent chemoradiotherapy (CCRT) has been the standard of care for patients with locally advanced non-small cell lung cancer (LA-NSCLC).
The results of the PACIFIC trial established the use of consolidative durvalumab after concurrent chemoradiotherapy (CCRT) as the standard of care for patients with locally advanced non-small cell lung cancer (LA-NSCLC). A subgroup analysis of the PACIFIC trial reported a better progression-free survival (PFS) in Asians. Although real-world data on LA-NSCLC patients who received CCRT plus durvalumab have been reported, there have been few large-scale reports on Asians. In this study, we investigated prognostic factors in the largest real-world data set in Asia of only Japanese LA-NSCLC patients treated with CCRT plus durvalumab.
One hundred and thirteen LA-NSCLC patients who received definitive CCRT and consolidative durvalumab at our institution between May 2018 and April 2021 were analyzed. Overall survival (OS), cause-specific survival (CSS), PFS, distant metastasis-free survival (DMFS), and in-field progression-free survival (IFPFS) were investigated as treatment outcomes using competing risk analyses.
During a median follow-up of 24 months (range, 5-47) after the initiation of durvalumab therapy, 31 patients died, of whom 23 died of lung cancer. In the multivariate analysis, the pretreatment factors that correlated with OS were ILA scores, adenocarcinoma, and performance status at the initiation of durvalumab. Furthermore, ILA score and programmed cell death ligand 1 (PD-L1) tumor proportion score (TPS) ≥ 1 % were significantly correlated with CSS, and PD-L1 TPS ≥ 1 % was significantly correlated with PFS and IFPFS.
Pretreatment ILA, adenocarcinoma, and performance status may have an impact on OS of LA-NSCLC patients receiving CCRT plus durvalumab.
同期放化疗（CCRT）一直是局部晚期非小细胞肺癌（LA-NSCLC）患者的标准治疗方法。
PACIFIC 试验的结果确立了在同步放化疗（CCRT）后使用巩固性度伐利尤单抗作为局部晚期非小细胞肺癌（LA-NSCLC）患者的标准治疗方法。PACIFIC 试验的亚组分析报告称，亚洲患者的无进展生存期（PFS）更好。尽管已经报道了接受 CCRT 加度伐利尤单抗治疗的 LA-NSCLC 患者的真实世界数据，但亚洲的大型报告很少。在这项研究中，我们调查了亚洲最大的真实世界数据集中仅接受 CCRT 加度伐利尤单抗治疗的日本 LA-NSCLC 患者的预后因素。
对我院 2018 年 5 月至 2021 年 4 月间接受确定性 CCRT 和巩固性度伐利尤单抗治疗的 113 例 LA-NSCLC 患者进行了分析。使用竞争风险分析调查了总生存期（OS）、特定原因生存（CSS）、无进展生存期（PFS）、远处转移无进展生存期（DMFS）和局部进展无进展生存期（IFPFS）作为治疗结果。
在开始度伐利尤单抗治疗后中位随访 24 个月（范围为 5-47 个月）期间，有 31 例患者死亡，其中 23 例死于肺癌。在多变量分析中，与 OS 相关的预处理因素是 ILA 评分、腺癌和开始度伐利尤单抗时的体能状态。此外，ILA 评分和程序性死亡配体 1（PD-L1）肿瘤比例评分（TPS）≥1%与 CSS 显著相关，PD-L1 TPS≥1%与 PFS 和 IFPFS 显著相关。
LA-NSCLC 患者接受 CCRT 加度伐利尤单抗治疗，治疗前的 ILA、腺癌和体能状态可能对 OS 有影响。
