Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Clin Lung Cancer. 2023 Jul;24(5):474-482. doi: 10.1016/j.cllc.2023.03.013. Epub 2023 Apr 3.
We sought to determine the proportion of patients with stage III non-small cell lung cancer (NSCLC) who initiate consolidation durvalumab or other immune checkpoint inhibitors (ICIs) after concurrent chemoradiotherapy (cCRT), as well as reasons for nonreceipt and prognostic implications.
We retrospectively identified consecutive patients with unresectable stage III NSCLC treated with definitive cCRT between October 2017 and December 2021 within a large US academic health system. Patients either received consolidation ICIs (ICI group) or did not (no-ICI group). Baseline characteristics and overall survival (OS) of the groups were assessed. Factors predictive of ICI nonreceipt were evaluated using logistic regression.
Of 333 patients who completed cCRT, 229 (69%) initiated consolidation ICIs; 104 (31%) did not. Reasons for ICI nonreceipt included progressive disease post-cCRT (N = 31, 9%), comorbidity or intercurrent illness (N = 25, 8%), cCRT toxicity (N = 23, 7%; 19/23 pneumonitis), and EGFR/ALK alteration (N = 14, 4%). The no-ICI group had worse performance status and a higher rate of baseline pulmonary comorbidity. Larger planning target volume was associated with post-cCRT progressive disease, and higher lung radiation dose with cCRT toxicity. Median OS was 16 months in the no-ICI group and 34.4 months in the ICI group. In the no-ICI group, OS was superior among those with EGFR/ALK alterations (median 44.5 months) and worst among those with progressive disease (median 5.9 months, P < 0.001).
31% of patients who completed cCRT for stage III NSCLC did not receive consolidation ICIs. Survival amongst these patients is poor, especially for those with progressive disease post-cCRT.
我们旨在确定在同步放化疗（cCRT）后，开始巩固性 durvalumab 或其他免疫检查点抑制剂（ICI）治疗的 III 期非小细胞肺癌（NSCLC）患者的比例，以及未接受治疗的原因和预后意义。
我们回顾性地确定了 2017 年 10 月至 2021 年 12 月期间在一家大型美国学术健康系统中接受根治性 cCRT 治疗的不可切除 III 期 NSCLC 连续患者。患者要么接受巩固性 ICI（ICI 组），要么未接受（非 ICI 组）。评估了两组的基线特征和总生存期（OS）。使用逻辑回归评估了预测 ICI 未接受的因素。
在完成 cCRT 的 333 名患者中，有 229 名（69%）开始接受巩固性 ICI；104 名（31%）未接受。ICI 未接受的原因包括 cCRT 后疾病进展（N=31，9%）、合并症或并发疾病（N=25，8%）、cCRT 毒性（N=23，7%；19/23 例肺炎）和 EGFR/ALK 改变（N=14，4%）。非 ICI 组的表现状态更差，基线肺部合并症的发生率更高。较大的计划靶区体积与 cCRT 后疾病进展相关，较高的肺部辐射剂量与 cCRT 毒性相关。非 ICI 组的中位 OS 为 16 个月，ICI 组为 34.4 个月。在非 ICI 组中，EGFR/ALK 改变的患者 OS 较好（中位 44.5 个月），疾病进展的患者 OS 最差（中位 5.9 个月，P<0.001）。
完成 III 期 NSCLC cCRT 的患者中有 31%未接受巩固性 ICI。这些患者的生存率较差，尤其是 cCRT 后疾病进展的患者。
