ESTRO 2022

Session Item

Lung

Session Code: 6008

Session Type: Poster (digital)

Track: Clinical

PFS and recurrence patterns after CCRT with durvalumab for stage III and recurrent NSCLC

Noriko Kishi, Japan

Presentation Number: PO-1279

Abstract

Abstract Title:

PFS and recurrence patterns after CCRT with durvalumab for stage III and recurrent NSCLC

Authors:

Noriko Kishi¹, Yukinori Matsuo¹, Takashi Shintani², Masakazu Ogura³, Takamasa Mitsuyoshi⁴, Norio Araki⁵, Kota Fujii⁶, Setsuko Okumura⁷, Kiyoshi Nakamatsu⁸, Takahiro Kishi⁹, Tomoko Atsuta¹⁰, Takashi Sakamoto¹¹, Shuji Otsu¹², Tomohiro Katagiri¹³, Masaru Narabayashi², Satsuki Fujishiro¹⁴, Yusuke Iizuka¹⁵, Hiroaki Ozasa¹⁶, Takashi Mizowaki¹

¹Kyoto University Graduate School of Medicine, Department of Radiation Oncology and Image-Applied Therapy, Kyoto, Japan; ²Japanese Red Cross Fukui Hospital, Department of Radiology, Fukui, Japan; ³Kishiwada City Hospital, Department of Radiation Oncology, Kishiwada, Japan; ⁴Kobe City Medical Center General Hospital, Department of Radiation Oncology, Kobe, Japan; ⁵National Hospital Organization Kyoto Medical Center, Department of Radiology, Kyoto, Japan; ⁶Kurashiki Central Hospital, Department of Radiation Oncology, Kurashiki, Japan; ⁷Hyogo Prefectural Amagasaki General Medical Center, Department of Radiation Oncology, Amagasaki, Japan; ⁸Kindai University Faculty of Medicine, Department of Radiation Oncology, Osakasayama, Japan; ⁹Osaka Red Cross Hospital, Department of Radiation Oncology, Osaka, Japan; ¹⁰Kitano Hospital, Tazuke Kofukai Medical Research Institute, Department of Radiology, Osaka, Japan; ¹¹Kyoto Katsura Hospital, Department of Radiation Oncology, Kyoto, Japan; ¹²Kyoto City Hospital, Department of Radiation Oncology, Kyoto, Japan; ¹³Tenri Hospital, Department of Radiation Oncology, Tenri, Japan; ¹⁴Shinko Hospital, Department of Radiation Oncology, Kobe, Japan; ¹⁵Shizuoka City Shizuoka Hospital, Department of Radiation Oncology, Shizuoka, Japan; ¹⁶Kyoto University Graduate School of Medicine, Department of Respiratory Medicine, Kyoto, Japan

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Purpose or Objective

To assess progression-free survival (PFS) and recurrence patterns after concurrent chemoradiotherapy (CCRT) followed by durvalumab in patients with non-small cell lung cancer (NSCLC).

Material and Methods

We conducted a multicenter retrospective study at 15 institutions in Japan. Patients receiving CCRT (prescribed dose ≥ 54 Gy) between July 2018 and July 2019 and consolidation durvalumab for stage III or postoperative recurrent NSCLC were enrolled.

Results

One hundred thirty-eight patients were eligible for the study. With a median follow-up period of 28.9 months [interquartile range, 25.1–32.2 months], the 24-month PFS rate was 40.4% (95% confidence interval, 33.0–49.6%). The multivariate analysis showed that the period from the last day of radiotherapy to durvalumab start ≥ 14 days and gross tumor volume (GTV) ≥ 56 cm³ were significantly associated with shorter PFS (P = 0.04 and 0.04, respectively). Among the eligible patients, 79 patients (57.2%) experienced any recurrences. Loco-regional recurrence as the initial recurrence occurred in 41 (29.7%) including 34 in-field recurrences (where ≥ 90% of the prescribed dose was irradiated). Squamous cell carcinoma and programmed cell death-ligand 1 (PD-L1) expression status < 50% were significantly associated with the in-field recurrence (P = 0.003 and 0.012, respectively). Distant metastasis occurred in 53 patients (38.4%). The most common sites were brain (16 patients), lung (13 patients), and adrenal gland (10 patients).

Conclusion

The real-world outcomes of Japanese patients with NSCLC treated with CCRT followed by durvalumab were consistent with the results reported in the PACIFIC trial. In-field recurrence is still a major problem after CCRT followed by durvalumab, and histological subtype and PD-L1 expression could be clues to an optimal treatment strategy for improving the outcomes.