Predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer
Abstract Background Concurrent chemoradiotherapy (CCRT) followed by durvalumab is the standard of care for unresectable locally-advanced non-small cell carcinoma (LA-NSCLC). However, a major concern about administration of durvalumab after CCRT is whether the incidence of symptomatic radiation pneum...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-021-01979-z |
| _version_ | 1818753772974768128 |
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| author | Hiroshi Mayahara Kazuyuki Uehara Aya Harada Keiji Kitatani Tomonori Yabuuchi Shuichirou Miyazaki Takeaki Ishihara Hiroki Kawaguchi Hikaru Kubota Hideaki Okada Taira Ninomaru Chihiro Shindo Akito Hata |
| author_facet | Hiroshi Mayahara Kazuyuki Uehara Aya Harada Keiji Kitatani Tomonori Yabuuchi Shuichirou Miyazaki Takeaki Ishihara Hiroki Kawaguchi Hikaru Kubota Hideaki Okada Taira Ninomaru Chihiro Shindo Akito Hata |
| author_sort | Hiroshi Mayahara |
| collection | DOAJ |
| description | Abstract Background Concurrent chemoradiotherapy (CCRT) followed by durvalumab is the standard of care for unresectable locally-advanced non-small cell carcinoma (LA-NSCLC). However, a major concern about administration of durvalumab after CCRT is whether the incidence of symptomatic radiation pneumonitis (RP) may increase or not. In the present analysis, we report the initial results of CCRT followed by durvalumab in patients with LA-NSCLC in a real-world setting with focus on predicting factors for symptomatic RP. Methods Patients who were pathologically diagnosed as NSCLC and initiated treatment with CCRT followed by durvalumab between July 2018 to December 2019 were eligible for this study. Patients were included if they completed the planned CRT course and administered at least one course of durvalumab. We retrospectively investigated the preliminary survival outcome and incidence and predicting factors for symptomatic RP. Results Of the 67 patients who planned CCRT, 63 patients completed the entire CCRT course. Of these, 56 patients proceeded to consolidation with durvalumab. The median time to eternal discontinuation of durvalumab was 9.7 months. The cumulative proportion of the patients who exhibited symptomatic RP was 30, 40 and 44% at 3, 6 and 12 months, respectively. In multivariate analyses, pulmonary fibrosis score and lung V40 were significant predictive factors for symptomatic RP (p < 0.001, HR: 7.83, 95% CI: 3.38–18.13, and p = 0.034, HR: 3.17, 95% CI: 1.09–9.19, respectively). Conclusions Pulmonary fibrosis sore and lung V40 were significant predictive factors for symptomatic RP. We should be cautious about the administration of durvalumab for patients having subclinical pulmonary fibrosis. To our best knowledge, this is one of the first report showing the predictive value of high dose volumes to the lung in patients with LA-NSCLC who received CCRT followed by durvalumab. |
| first_indexed | 2024-12-18T05:12:41Z |
| format | Article |
| id | doaj.art-529cb1f3ea8446459348acdab30eb089 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-12-18T05:12:41Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-529cb1f3ea8446459348acdab30eb0892022-12-21T21:19:50ZengBMCRadiation Oncology1748-717X2022-01-0117111010.1186/s13014-021-01979-zPredicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancerHiroshi Mayahara0Kazuyuki Uehara1Aya Harada2Keiji Kitatani3Tomonori Yabuuchi4Shuichirou Miyazaki5Takeaki Ishihara6Hiroki Kawaguchi7Hikaru Kubota8Hideaki Okada9Taira Ninomaru10Chihiro Shindo11Akito Hata12Department of Radiation Oncology, Kobe Minimally-invasive Cancer CenterDepartment of Radiation Oncology, Kobe Minimally-invasive Cancer CenterDepartment of Radiation Oncology, Kobe Minimally-invasive Cancer CenterDepartment of Radiation Oncology, Kobe Minimally-invasive Cancer CenterDepartment of Radiation Oncology, Kobe Minimally-invasive Cancer CenterDepartment of Radiation Oncology, Kobe Minimally-invasive Cancer CenterDivision of Radiation Oncology, Kobe University Graduate School of MedicineDivision of Radiation Oncology, Kobe University Graduate School of MedicineDivision of Radiation Oncology, Kobe University Graduate School of MedicineDepartment of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer CenterDepartment of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer CenterDepartment of Diagnostic Radiology, Kobe Minimally-invasive Cancer CenterDepartment of Respiratory Medical Oncology, Kobe Minimally-invasive Cancer CenterAbstract Background Concurrent chemoradiotherapy (CCRT) followed by durvalumab is the standard of care for unresectable locally-advanced non-small cell carcinoma (LA-NSCLC). However, a major concern about administration of durvalumab after CCRT is whether the incidence of symptomatic radiation pneumonitis (RP) may increase or not. In the present analysis, we report the initial results of CCRT followed by durvalumab in patients with LA-NSCLC in a real-world setting with focus on predicting factors for symptomatic RP. Methods Patients who were pathologically diagnosed as NSCLC and initiated treatment with CCRT followed by durvalumab between July 2018 to December 2019 were eligible for this study. Patients were included if they completed the planned CRT course and administered at least one course of durvalumab. We retrospectively investigated the preliminary survival outcome and incidence and predicting factors for symptomatic RP. Results Of the 67 patients who planned CCRT, 63 patients completed the entire CCRT course. Of these, 56 patients proceeded to consolidation with durvalumab. The median time to eternal discontinuation of durvalumab was 9.7 months. The cumulative proportion of the patients who exhibited symptomatic RP was 30, 40 and 44% at 3, 6 and 12 months, respectively. In multivariate analyses, pulmonary fibrosis score and lung V40 were significant predictive factors for symptomatic RP (p < 0.001, HR: 7.83, 95% CI: 3.38–18.13, and p = 0.034, HR: 3.17, 95% CI: 1.09–9.19, respectively). Conclusions Pulmonary fibrosis sore and lung V40 were significant predictive factors for symptomatic RP. We should be cautious about the administration of durvalumab for patients having subclinical pulmonary fibrosis. To our best knowledge, this is one of the first report showing the predictive value of high dose volumes to the lung in patients with LA-NSCLC who received CCRT followed by durvalumab.https://doi.org/10.1186/s13014-021-01979-zLocally advanced non-small cell lung cancerConcurrent chemoradiotherapyRadiation pneumonitisDosimetric factorDurvalumab |
| spellingShingle | Hiroshi Mayahara Kazuyuki Uehara Aya Harada Keiji Kitatani Tomonori Yabuuchi Shuichirou Miyazaki Takeaki Ishihara Hiroki Kawaguchi Hikaru Kubota Hideaki Okada Taira Ninomaru Chihiro Shindo Akito Hata Predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer Radiation Oncology Locally advanced non-small cell lung cancer Concurrent chemoradiotherapy Radiation pneumonitis Dosimetric factor Durvalumab |
| title | Predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer |
| title_full | Predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer |
| title_fullStr | Predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer |
| title_full_unstemmed | Predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer |
| title_short | Predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non-small cell lung cancer |
| title_sort | predicting factors of symptomatic radiation pneumonitis induced by durvalumab following concurrent chemoradiotherapy in locally advanced non small cell lung cancer |
| topic | Locally advanced non-small cell lung cancer Concurrent chemoradiotherapy Radiation pneumonitis Dosimetric factor Durvalumab |
| url | https://doi.org/10.1186/s13014-021-01979-z |
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