Pneumonitis After Chemoradiotherapy and Adjuvant Durvalumab in Stage III Non-Small Cell Lung Cancer

被引：2

作者：

Edwards, Donna M. ^{[1
,2
]}

Sankar, Kamya ^{[2
,3
]}

Alseri, Aaren ^{[4
]}

Jiang, Ralph ^{[1
,5
]}

Schipper, Matthew ^{[1
,5
]}

Miller, Sean ^{[1
,2
]}

Dess, Kathryn ^{[1
,2
]}

Strohbehn, Garth W. ^{[5
,6
,7
,8
,9
,10
]}

Moghanaki, Drew ^{[11
]}

Ramnath, Nithya ^{[5
,6
]}

Green, Michael D. ^{[1
,2
,6
,12
]}

Bryant, Alex K. ^{[1
,2
]}

机构：

[1] Univ Michigan, Dept Radiat Oncol, Ann Arbor, MI 48109 USA

[2] Vet Affairs Ann Arbor Healthcare Syst, Dept Radiat Oncol, Ann Arbor, MI 48105 USA

[3] Cedars Sinai Med Ctr, Samuel Oschin Comprehens Canc Inst, Dept Med, Div Med Oncol, Los Angeles, CA USA

[4] Vet Affairs Ann Arbor Healthcare Syst, Dept Radiol, Ann Arbor, MI USA

[5] Univ Michigan, Dept Biostat, Ann Arbor, MI USA

[6] Univ Michigan, Rogel Canc Ctr, Ann Arbor, MI USA

[7] Univ Michigan, Dept Med, Div Hematol Oncol, Ann Arbor, MI USA

[8] Vet Affairs Ann Arbor Healthcare Syst, Dept Med, Div Hematol Oncol, Ann Arbor, MI USA

[9] VA Ctr Clin Management Res, Ann Arbor, MI USA

[10] UCLA, Jonsson Canc Ctr, Dept Radiat Oncol, Los Angeles, CA USA

[11] Vet Affairs Los Angeles Healthcare Syst, Dept Radiat Oncol, Los Angeles, CA USA

[12] Univ Michigan, Dept Microbiol & Immunol, Ann Arbor, MI USA

来源：

INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2024年 / 118卷 / 04期

关键词：

RADIATION PNEUMONITIS; RISK-FACTORS; CONCURRENT CHEMORADIOTHERAPY; CHEMORADIATION;

D O I：

10.1016/j.ijrobp.2023.09.050

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Purpose: Adjuvant durvalumab after definitive chemoradiotherapy (CRT) for unresectable stage III non -small cell lung cancer (NSCLC) is well -tolerated in clinical trials. However, pneumonitis rates outside of clinical trials remain poorly defined with CRT followed by durvalumab. We aimed to describe the influence of durvalumab on pneumonitis rates among a large cohort of patients with stage III NSCLC. Methods and Materials: We studied patients with stage III NSCLC in the national Veterans Health Administration from 2015 to 2021 who received concurrent CRT alone or with adjuvant durvalumab. We defined pneumonitis as worsening respiratory symptoms with radiographic changes within 2 years of CRT and graded events according to National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03. We used Cox regression to analyze risk factors for pneumonitis and the effect of postbaseline pneumonitis on overall survival. Results: Among 1994 patients (989 CRT alone, 1005 CRT followed by adjuvant durvalumab), the 2 -year incidence of grade 2 or higher pneumonitis was 13.9% for CRT alone versus 22.1% for CRT plus durvalumab (unadjusted P < .001). On multivariable analysis, durvalumab was associated with higher risk of grade 2 pneumonitis (hazard ratio, 1.45; 95% CI, 1.09-1.93; P = .012) but not grade 3 to 5 pneumonitis (P = .2). Grade 3 pneumonitis conferred worse overall survival (hazard ratio, 2.51; 95% CI, 2.06-3.05; P < .001) but grade 2 pneumonitis did not (P = .4). Conclusions: Adjuvant durvalumab use was associated with increased risk of low-grade but not higher -grade pneumonitis. Reassuringly, low-grade pneumonitis did not increase mortality risk. We observed increased rates of high-grade pneumonitis relative to clinical trials; the reasons for this require further study. Published by Elsevier Inc.

引用

页码：963 / 970

页数：8