Ellison Ciani, Martens Michael, Alvarez Argote Juliana, Benz Samantha, Currey Adam, Johnstone Candice, Klawikowski Slade, Livingston Katie, Longo John M, Menon Smitha, Ortiz de Choudens Saryleine, Puckett Lindsay, Retseck Janet, Shukla Monica, Thompson Jonathan, Gore Elizabeth
Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin.
JTO Clin Res Rep. 2023 Jun 15;5(12):100537. doi: 10.1016/j.jtocrr.2023.100537. eCollection 2024 Dec.
The standard of care for unresectable locally advanced NSCLC is concurrent chemotherapy and radiation (CRT) followed by adjuvant durvalumab, established by the PACIFIC trial, which revealed acceptable although higher rates of pneumonitis with durvaluamb than placebo. We retrospectively reviewed patients with locally advanced NSCLC from 2018 to 2022 treated with definitive CRT (≥60 Gy) followed by at least one dose of adjuvant durvalumab.
To review the incidence of pneumonitis and contributing factors, and also to review grade 5 pneumonitis (G5) events.
We identified 78 cases with a median age of 70.0 years and a median follow-up of 36 months. All patients received CRT of at least 60 Gy at 2 Gy per fraction. A total of 22 patients (28.2%) completed 12 months of durvalumab. The cumulative incidence of any-grade pneumonitis was 28.2%. Pneumonitis rate in grades 1, 2, 3, 4, and 5 was 1.3%, 10.3%, 7.7%, 0.0%, and 9.0%, respectively.
Multivariate analysis did not reveal significant factors associated with G5 pneumonitis. There were 8 patients who received radiation therapy doses above standard limits and, of these, only two developed G5 pneumonitis. All patients with G5 pneumonitis had multiple comorbidities or previous malignancy treated with systemic therapy. The median overall survival was 31.1 months and the median progression-free survival was 12.7 months.
We report comparable overall rates of pneumonitis relative to published data with higher rates of G5 pneumonitis. Patients with high-dose radiation therapy (≥60 Gy) and Eastern Cooperative Oncology Group performance status greater than or equal to 2 may tolerate adjuvant durvalumab, though providers should exercise caution in patients with extensive comorbidities.
不可切除的局部晚期非小细胞肺癌（NSCLC）的标准治疗方案是同步放化疗（CRT），随后使用辅助性度伐利尤单抗，这是由PACIFIC试验确定的。该试验显示，与安慰剂相比，度伐利尤单抗导致的肺炎发生率虽较高但仍可接受。我们回顾性分析了2018年至2022年期间接受根治性CRT（≥60 Gy）并随后接受至少一剂辅助性度伐利尤单抗治疗的局部晚期NSCLC患者。
回顾肺炎的发生率及相关因素，并回顾5级肺炎（G5）事件。
我们确定了78例患者，中位年龄为70.0岁，中位随访时间为36个月。所有患者均接受了至少60 Gy的CRT，每次分割剂量为2 Gy。共有22例患者（28.2%）完成了12个月的度伐利尤单抗治疗。任何级别的肺炎累积发生率为28.2%。1级、2级、3级、4级和5级肺炎的发生率分别为1.3%、10.3%、7.7%、0.0%和9.0%。
多因素分析未发现与G5肺炎相关的显著因素。有8例患者接受的放射治疗剂量高于标准限值，其中只有2例发生了G5肺炎。所有G5肺炎患者都有多种合并症或既往接受过全身治疗的恶性肿瘤。中位总生存期为31.1个月，中位无进展生存期为12.7个月。
我们报告的肺炎总体发生率与已发表数据相当，但G5肺炎发生率较高。接受高剂量放疗（≥60 Gy）且东部肿瘤协作组体能状态大于或等于2的患者可能耐受辅助性度伐利尤单抗，不过对于合并症广泛的患者，医疗人员应谨慎使用。
