Treatment-Related Pulmonary Adverse Events Induced by Chemoradiation and Durvalumab Affect Survival in Locally Advanced Non-Small Cell Lung Cancer

Authors

Ting Xu
Lirong Wu
Saumil Gandhi
Wang Jing
Quyhn-Nhu Nguyen
Aileen Chen
Joe Y Chang
Roza Nurieva
Ajay Sheshadri
Mehmet Altan
Percy P Lee
Steven H Lin
Zhongxing Liao

Publication Date

11-1-2022

Journal

Radiotherapy & Oncology

DOI

10.1016/j.radonc.2022.10.002

PMID

36209942

PMCID

PMC11813632

PubMedCentral® Posted Date

2-11-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

Purpose: We compared treatment-related pulmonary adverse events (TRPAE), progression-free survival (PFS), and overall survival (OS) among locally advanced non-small cell lung cancer (NSCLC) patients who received concurrent chemoradiotherapy (CRT) versus CRT followed by immune check point inhibitor (ICI) immunotherapy (CRTI).

Materials and methods: TRPAE was defined as any pulmonary events as defined in CTCAE v.5 occurring within 12 months after completion of radiotherapy. Outcomes were compared between CRT and CTRI by Cox proportional hazard regression and Kaplan-Meier analyses. We also assessed if TRPAE-induced discontinuation of ICI affected survival.

Results: We analyzed 326 patients treated between July 2010 and November 2019; 195 patients received CRT and 131 received CRTI. The incidences of severe grade ≥ 3 TRPAE were similar between the two groups, however, symptomatic TRPAE was almost doubled in CRTI group (65.7 % CTRI vs 35.9 % CRT, P < 0.0001). The rates of 4-year OS and PFS were 54.5 % vs 36.7 % (P = 0.0003) and 43.8 % vs 35.8 % (P = 0.038) in CRT + Durvalumab and CRT group, respectively. Receipt of ICI Durvalumab was associated with better 4-year OS (HR 0.53, 95 % CI 0.36-0.78, P = 0.001) and PFS (HR 0.55, 95 % CI 0.38-0.80, P = 0.002). Patients who discontinued ICI because of TRPAE had worse 4-year OS (P = 0.001) and higher rates of distant metastasis (P = 0.003) than those who completed planned ICI after developing TRPAE.

Conclusion: CRT followed by adjuvant ICI led to improved 4-year OS and PFS consistent with published data. CRTI was associated with higher incidence of grade ≥ 2 TRPAE in both high and low mean lung dose groups without significant difference in grade ≥ 3 TRPAE. Discontinuation of ICI due to TRPAE was associated with poorer OS and distant disease control than completing ICI as planned after developing TRPAE.

Keywords

Humans, Carcinoma, Non-Small-Cell Lung, Lung Neoplasms, Chemoradiotherapy, Lung, Concurrent chemoradiotherapy, Adjuvant immunotherapy, Disease outcome, Pulmonary toxicities, Non-small cell lung cancer

Published Open-Access

yes

Recommended Citation

Xu, Ting; Wu, Lirong; Gandhi, Saumil; et al., "Treatment-Related Pulmonary Adverse Events Induced by Chemoradiation and Durvalumab Affect Survival in Locally Advanced Non-Small Cell Lung Cancer" (2022). Faculty, Staff and Student Publications. 4746.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4746