309P - Pneumonitis and corticosteroid treatment in patients with unresectable non-small cell lung cancer receiving durvalumab consolidation after definitive chemoradiotherapy

Background

Durvalumab consolidation after definitive chemoradiotherapy (CRT) is the standard of care for locally advanced, unresectable non-small cell lung cancer (NSCLC). Clinicopathological features of pneumonitis and its treatment using corticosteroid have not been adequately investigated.

Methods

We analyzed medical records of patients treated with CRT for locally advanced, unresectable NSCLC between January 2014 and February 2021 at the National Cancer Center Hospital, Japan. We collected clinical information including patient characteristics, durvalumab administration, presence or absence of pneumonitis, and use of corticosteroids.

Results

A total of 261 patients with locally advanced, unresectable NSCLC were treated by CRT. The patient characteristics were as follows: males: 195 (75%); median age: 66 (range: 28-84) years; smokers: 224 (86%); histology: 148 adenocarcinoma (57%); median radiation dose: 60Gy (range: 26-71). The chemotherapy combined with cisplatin plus vinorelbine was used in 189 patients (72%). In Japan, durvalumab was approved in August 2018. One hundred thirty-five patients started CRT without durvalumab before April 2018, and 126 started CRT after April 2018. In the latter patient population, 101 patients received durvalumab consolidation therapy, and the median time from the end of CRT to the start of durvalumab was 15 days. The incidence of pneumonitis was 49% vs. 78%. The percentage of patients who received corticosteroids for pneumonitis was 46% vs. 44%. The median days from the end of CRT to the onset of pneumonitis was 133 vs. 105 days, respectively. Seventy-nine percent of patients were able to continue receiving durvalumab after the onset of pneumonitis, and 21% discontinued. The number of cases in which corticosteroids could not be completed at once was clearly higher in patients after durvalumab approval (17% vs. 44%), and the median duration of corticosteroid administration was also longer (49 (range: 3-148) days vs. 112 (range: 5-616) days). Table: 309P

Conclusions

In patients who received durvalumab, the incidence of pneumonitis was higher, and the duration of corticosteroid therapy for pneumonitis was longer in comparison to patients who received CRT without durvalumab.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

H. Horinouchi: Financial Interests, Personal, Invited Speaker: AstraZeneca, Eli Lilly, BMS/ONO, Merck Sharp & Dohme, Roche/Chugai, Novartis, Pfizer, Boehringer Ingelheim, Kyowa-Kirin, Nihon Kayaku, Abbvie, Roche/Chugai; Financial Interests, Personal, Advisory Board: AstraZeneca, Eli Lilly, BMS/ONO, Merck Sharp & Dohme, Roche/Chugai, Amgen, Nihon Kayaku; Financial Interests, Institutional, Research Grant: Roche/Chugai, Merck Sharp & Dohme, Daiichi-Sankyo, ONO pharmaceutical, AstraZeneca; Financial Interests, Institutional, Invited Speaker: Abbvie. Y. Okuma: Financial Interests, Personal, Invited Speaker: AstraZeneca, K. K., Nippon Boehringer Ingelheim, Chugai Phamaceutical Co., Ltd., Eli Lilly K. K., Ono Pharmaceutical Co., Ltd., Taiho Pharmacuetical Co., Ltd., Takeda Pharmacuetical Co., Ltd., Pfizer Japan Inc., AbbVie, G.K., Chugai Co., Ltd. Y. Goto: Financial Interests, Personal, Advisory Board: AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Chugai, Daiichi Sankyo, Eli Lilly, Guardant Health Inc., Illumina, MSD, Novartis, Ono Pharmaceutical, Pfizer, Taiho, Johnson and Johnson, D3bio; Financial Interests, Personal, Invited Speaker: AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Chugai, Daiichi Sankyo, Eli Lilly, Merck, MSD, Novartis, Ono Pharmaceutical, Thermo Fischer, Pfizer, Taiho; Financial Interests, Institutional, Invited Speaker: Bristol Myers Squibb, DaiichiSankyo, Eli Lilly, Guardant Health, Preferred Network; Financial Interests, Personal and Institutional, Invited Speaker: Chugai, Novartis, Pfizer; Financial Interests, Institutional, Research Grant: Prefered Network. N. Yamamoto: Financial Interests, Personal, Invited Speaker: Pfizer, AstraZeneca, Eli Lilly, ONO, Chugai, Sysmex, Daiichi-Sankyo; Financial Interests, Personal, Advisory Board: Eisai, Takeda, Otsuka, Boehringer Ingelheim, Cimic, Chugai; Financial Interests, Institutional, Invited Speaker, Principal Investigator in industry sponsored trial: Astellas, Chugai, Eisai, Taiho, BMS, Pfizer, Novartis, Eli Lilly, AbbVie, Daiichi-Sankyo, Bayer, Boehringer Ingelheim, Kyowa-Hakko Kirin, Takeda, ONO, Janssen Pharma, MSD, MERCK, GSK, Sumitomo Dainippon, Chiome Bioscience, Otsuka; Financial Interests, Institutional, Invited Speaker, Principal investigator in industry sponsored trial: Carna Biosciences, Genmab, Shionogi, TORAY. M. Kusumoto: Financial Interests, Personal, Invited Speaker: Daiichi-Sankyo Co. Ltd. Y. Ohe: Financial Interests, Personal, Invited Speaker: AstraZeneca, Chugai, ONO, BMS, Eli Lilly, Boehringer Ingelheim, Takeda, MSD, Novartis; Financial Interests, Personal, Advisory Board: AstraZaneca, BMS, Celltrion, Amgen, Nippon Kayaku, Takeda, Pfizer, ONO, Janssen, AnHeart Therapeutics Inc; Financial Interests, Institutional, Invited Speaker: AstraZeneca, Eli Lilly, Janssen, Amgen; Financial Interests, Personal and Institutional, Invited Speaker: Takeda, ONO; Non-Financial Interests, Personal, Leadership Role: JSMO, JLCS, JCOG; Non-Financial Interests, Personal, Member: ASCO. All other authors have declared no conflicts of interest.