Predictors of Pneumonitis in Patients With Locally Advanced Non-Small Cell Lung Cancer Treated With Definitive Chemoradiation Followed by Consolidative Durvalumab
Purpose: In patients with locally advanced, unresectable non-small cell lung cancer (NSCLC), the standard of care is concurrent chemoradiation (CRT) followed by consolidative immunotherapy with durvalumab. Pneumonitis is a known adverse event of both radiation therapy and immune checkpoint inhibitor...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-03-01
|
| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109422002366 |
| _version_ | 1797945517564493824 |
|---|---|
| author | Brett H. Diamond, MD Neel Belani, MD Rebecca Masel, MD Kathryn DeCarli, MD, MBE Thomas DiPetrillo, MD Jaroslaw T. Hepel, MD Christopher G. Azzoli, MD Humera Khurshid, MD Abbas Abbas, MD Paul P. Koffer, MD |
| author_facet | Brett H. Diamond, MD Neel Belani, MD Rebecca Masel, MD Kathryn DeCarli, MD, MBE Thomas DiPetrillo, MD Jaroslaw T. Hepel, MD Christopher G. Azzoli, MD Humera Khurshid, MD Abbas Abbas, MD Paul P. Koffer, MD |
| author_sort | Brett H. Diamond, MD |
| collection | DOAJ |
| description | Purpose: In patients with locally advanced, unresectable non-small cell lung cancer (NSCLC), the standard of care is concurrent chemoradiation (CRT) followed by consolidative immunotherapy with durvalumab. Pneumonitis is a known adverse event of both radiation therapy and immune checkpoint inhibitors such as durvalumab. We sought to characterize pneumonitis rates and dosimetric predictors of pneumonitis in a real-world population of patients with NSCLC treated with definitive CRT followed by consolidative durvalumab. Methods and Materials: Patients with NSCLC from a single institution who were treated with definitive CRT followed by consolidative durvalumab were identified. Outcomes of interest included pneumonitis incidence, type of pneumonitis, progression-free survival, and overall survival. Results: Sixty-two patients were included in our data set treated from 2018 to 2021 with a median follow-up of 17 months. The rate of grade 2+ pneumonitis in our cohort was 32.3%, and the rate of grade 3+ pneumonitis was 9.7%. Lung dosimetry parameters including V20 ≥30% and mean lung dose (MLD) >18 Gy were found to be correlated with increased rates of grade 2+ and grade 3+ pneumonitis. Patients with a lung V20 ≥30% had a grade 2+ pneumonitis rate at 1 year of 49.8% compared with 17.8% in patients with a lung V20 <30% (P = .015). Similarly, patients with an MLD >18 Gy had a grade 2+ pneumonitis rate at 1 year of 52.4% compared with 25.8% in patients with an MLD ≤18 Gy (P = .01). Moreover, heart dosimetry parameters including mean heart dose ≥10 Gy were found to be correlated with increased rates of grade 2+ pneumonitis. The estimated 1-year overall survival and progression-free survival of our cohort were 86.8% and 64.1%, respectively. Conclusions: The modern management of locally advanced, unresectable NSCLC involves definitive chemoradiation followed by consolidative durvalumab. Pneumonitis rates were higher than expected in this cohort, particularly for patients with a lung V20 ≥30%, MLD >18 Gy, and mean heart dose ≥10 Gy, suggesting that more stringent radiation planning dose constraints may be needed. |
| first_indexed | 2024-04-10T20:56:22Z |
| format | Article |
| id | doaj.art-1d82d7753a82465b8c3feb213e3b1ccd |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-04-10T20:56:22Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-1d82d7753a82465b8c3feb213e3b1ccd2023-01-23T04:08:34ZengElsevierAdvances in Radiation Oncology2452-10942023-03-0182101130Predictors of Pneumonitis in Patients With Locally Advanced Non-Small Cell Lung Cancer Treated With Definitive Chemoradiation Followed by Consolidative DurvalumabBrett H. Diamond, MD0Neel Belani, MD1Rebecca Masel, MD2Kathryn DeCarli, MD, MBE3Thomas DiPetrillo, MD4Jaroslaw T. Hepel, MD5Christopher G. Azzoli, MD6Humera Khurshid, MD7Abbas Abbas, MD8Paul P. Koffer, MD9Department of Radiation Oncology, Rhode Island Hospital, Providence, Rhode Island; Department of Radiation Oncology, Tufts Medical Center, Boston, MassachusettsDepartment of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PennsylvaniaDepartment of Medicine, Rhode Island Hospital, Providence, Rhode IslandWarren Alpert School of Medicine, Providence, Rhode Island; Department of Medical Oncology, Rhode Island Hospital, Providence, Rhode IslandDepartment of Radiation Oncology, Rhode Island Hospital, Providence, Rhode Island; Department of Radiation Oncology, Tufts Medical Center, Boston, Massachusetts; Warren Alpert School of Medicine, Providence, Rhode IslandDepartment of Radiation Oncology, Rhode Island Hospital, Providence, Rhode Island; Warren Alpert School of Medicine, Providence, Rhode IslandWarren Alpert School of Medicine, Providence, Rhode Island; Department of Medical Oncology, Rhode Island Hospital, Providence, Rhode IslandWarren Alpert School of Medicine, Providence, Rhode Island; Department of Medical Oncology, Rhode Island Hospital, Providence, Rhode IslandWarren Alpert School of Medicine, Providence, Rhode Island; Department of Thoracic Surgery, Rhode Island Hospital, Providence, Rhode IslandDepartment of Radiation Oncology, Rhode Island Hospital, Providence, Rhode Island; Warren Alpert School of Medicine, Providence, Rhode Island; Corresponding author: Paul P. Koffer, MDPurpose: In patients with locally advanced, unresectable non-small cell lung cancer (NSCLC), the standard of care is concurrent chemoradiation (CRT) followed by consolidative immunotherapy with durvalumab. Pneumonitis is a known adverse event of both radiation therapy and immune checkpoint inhibitors such as durvalumab. We sought to characterize pneumonitis rates and dosimetric predictors of pneumonitis in a real-world population of patients with NSCLC treated with definitive CRT followed by consolidative durvalumab. Methods and Materials: Patients with NSCLC from a single institution who were treated with definitive CRT followed by consolidative durvalumab were identified. Outcomes of interest included pneumonitis incidence, type of pneumonitis, progression-free survival, and overall survival. Results: Sixty-two patients were included in our data set treated from 2018 to 2021 with a median follow-up of 17 months. The rate of grade 2+ pneumonitis in our cohort was 32.3%, and the rate of grade 3+ pneumonitis was 9.7%. Lung dosimetry parameters including V20 ≥30% and mean lung dose (MLD) >18 Gy were found to be correlated with increased rates of grade 2+ and grade 3+ pneumonitis. Patients with a lung V20 ≥30% had a grade 2+ pneumonitis rate at 1 year of 49.8% compared with 17.8% in patients with a lung V20 <30% (P = .015). Similarly, patients with an MLD >18 Gy had a grade 2+ pneumonitis rate at 1 year of 52.4% compared with 25.8% in patients with an MLD ≤18 Gy (P = .01). Moreover, heart dosimetry parameters including mean heart dose ≥10 Gy were found to be correlated with increased rates of grade 2+ pneumonitis. The estimated 1-year overall survival and progression-free survival of our cohort were 86.8% and 64.1%, respectively. Conclusions: The modern management of locally advanced, unresectable NSCLC involves definitive chemoradiation followed by consolidative durvalumab. Pneumonitis rates were higher than expected in this cohort, particularly for patients with a lung V20 ≥30%, MLD >18 Gy, and mean heart dose ≥10 Gy, suggesting that more stringent radiation planning dose constraints may be needed.http://www.sciencedirect.com/science/article/pii/S2452109422002366 |
| spellingShingle | Brett H. Diamond, MD Neel Belani, MD Rebecca Masel, MD Kathryn DeCarli, MD, MBE Thomas DiPetrillo, MD Jaroslaw T. Hepel, MD Christopher G. Azzoli, MD Humera Khurshid, MD Abbas Abbas, MD Paul P. Koffer, MD Predictors of Pneumonitis in Patients With Locally Advanced Non-Small Cell Lung Cancer Treated With Definitive Chemoradiation Followed by Consolidative Durvalumab Advances in Radiation Oncology |
| title | Predictors of Pneumonitis in Patients With Locally Advanced Non-Small Cell Lung Cancer Treated With Definitive Chemoradiation Followed by Consolidative Durvalumab |
| title_full | Predictors of Pneumonitis in Patients With Locally Advanced Non-Small Cell Lung Cancer Treated With Definitive Chemoradiation Followed by Consolidative Durvalumab |
| title_fullStr | Predictors of Pneumonitis in Patients With Locally Advanced Non-Small Cell Lung Cancer Treated With Definitive Chemoradiation Followed by Consolidative Durvalumab |
| title_full_unstemmed | Predictors of Pneumonitis in Patients With Locally Advanced Non-Small Cell Lung Cancer Treated With Definitive Chemoradiation Followed by Consolidative Durvalumab |
| title_short | Predictors of Pneumonitis in Patients With Locally Advanced Non-Small Cell Lung Cancer Treated With Definitive Chemoradiation Followed by Consolidative Durvalumab |
| title_sort | predictors of pneumonitis in patients with locally advanced non small cell lung cancer treated with definitive chemoradiation followed by consolidative durvalumab |
| url | http://www.sciencedirect.com/science/article/pii/S2452109422002366 |
| work_keys_str_mv | AT bretthdiamondmd predictorsofpneumonitisinpatientswithlocallyadvancednonsmallcelllungcancertreatedwithdefinitivechemoradiationfollowedbyconsolidativedurvalumab AT neelbelanimd predictorsofpneumonitisinpatientswithlocallyadvancednonsmallcelllungcancertreatedwithdefinitivechemoradiationfollowedbyconsolidativedurvalumab AT rebeccamaselmd predictorsofpneumonitisinpatientswithlocallyadvancednonsmallcelllungcancertreatedwithdefinitivechemoradiationfollowedbyconsolidativedurvalumab AT kathryndecarlimdmbe predictorsofpneumonitisinpatientswithlocallyadvancednonsmallcelllungcancertreatedwithdefinitivechemoradiationfollowedbyconsolidativedurvalumab AT thomasdipetrillomd predictorsofpneumonitisinpatientswithlocallyadvancednonsmallcelllungcancertreatedwithdefinitivechemoradiationfollowedbyconsolidativedurvalumab AT jaroslawthepelmd predictorsofpneumonitisinpatientswithlocallyadvancednonsmallcelllungcancertreatedwithdefinitivechemoradiationfollowedbyconsolidativedurvalumab AT christophergazzolimd predictorsofpneumonitisinpatientswithlocallyadvancednonsmallcelllungcancertreatedwithdefinitivechemoradiationfollowedbyconsolidativedurvalumab AT humerakhurshidmd predictorsofpneumonitisinpatientswithlocallyadvancednonsmallcelllungcancertreatedwithdefinitivechemoradiationfollowedbyconsolidativedurvalumab AT abbasabbasmd predictorsofpneumonitisinpatientswithlocallyadvancednonsmallcelllungcancertreatedwithdefinitivechemoradiationfollowedbyconsolidativedurvalumab AT paulpkoffermd predictorsofpneumonitisinpatientswithlocallyadvancednonsmallcelllungcancertreatedwithdefinitivechemoradiationfollowedbyconsolidativedurvalumab |