Langberg Christian Wilhelm, Horndalsveen Henrik, Helland Åslaug, Haakensen Vilde Drageset
Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Oncology, Oslo University Hospital, Oslo, Norway.
Front Oncol. 2023 Jul 5;13:1217424. doi: 10.3389/fonc.2023.1217424. eCollection 2023.
The introduction of consolidation immunotherapy after chemoradiotherapy has improved outcome for patients with locally advanced non-small cell lung cancer. However, not all patients receive this treatment. This study identifies factors associated with failure to start durvalumab as consolidation therapy with the aim of optimizing treatment, supportive care and prehabilitation to ensure that more patients complete the planned treatment.
Patients from two clinical trials and a named patient use program, were included in this study. All patients received platinum-doublet chemotherapy concomitant with radiotherapy to a total dose of 60-66 gray. Patient characteristics, cancer treatment, toxicity, performance status and laboratory data before and after chemoradiotherapy were recorded and patients who never started durvalumab were compared with those who did.
A total of 101 patients were included, of which 83 started treatments with durvalumab after chemoradiotherapy. The 18 patients who did not start durvalumab had significantly higher lactate dehydrogenase at baseline and a worse performance status, cumulative toxicity and higher c-reactive protein after completed chemoradiotherapy. Data also suggest that pre-treatment diabetes and reduced hemoglobin and/or diffusion capacity of the lungs for carbon monoxide contribute to the risk of treatment abruption.
Treatment plan disruption rate was 18%. Systemic inflammation and performance status were associated with failure to receive durvalumab after chemoradiation. Further studies are needed to confirm findings and prospective trials should investigate whether prehabilitation and supportive treatment could help more patients finishing the planned treatment.
clinicaltrials.gov, identifier NCT03798535; NCT04392505.
放化疗后引入巩固性免疫治疗改善了局部晚期非小细胞肺癌患者的预后。然而，并非所有患者都接受这种治疗。本研究确定了与未开始使用度伐利尤单抗进行巩固治疗相关的因素，旨在优化治疗、支持性护理和术前康复，以确保更多患者完成计划的治疗。
本研究纳入了来自两项临床试验和一个命名患者使用项目的患者。所有患者均接受铂类双联化疗并同步放疗，总剂量为60-66格雷。记录患者特征、癌症治疗情况、毒性反应、体能状态以及放化疗前后的实验室数据，并将从未开始使用度伐利尤单抗的患者与使用该药物的患者进行比较。
共纳入101例患者，其中83例在放化疗后开始使用度伐利尤单抗进行治疗。未开始使用度伐利尤单抗的18例患者在基线时乳酸脱氢酶水平显著更高，体能状态更差，放化疗完成后的累积毒性反应更大且C反应蛋白水平更高。数据还表明，治疗前的糖尿病以及血红蛋白降低和/或肺一氧化碳弥散能力下降会增加治疗中断的风险。
治疗计划中断率为18%。全身炎症反应和体能状态与放化疗后未接受度伐利尤单抗治疗有关。需要进一步研究来证实这些发现，前瞻性试验应调查术前康复和支持性治疗是否有助于更多患者完成计划的治疗。
clinicaltrials.gov，标识符NCT03798535；NCT04392505。
