522P - Durvalumab plus etoposide and carboplatin for extensive-stage small cell lung cancer with mild idiopathic interstitial pneumonia

Background

Adding an immune checkpoint inhibitor (ICI) to chemotherapy has demonstrated efficacy in treating extensive-stage small cell lung cancer (ES-SCLC). However, patients with idiopathic interstitial pneumonia (IIP) have a higher risk of developing pneumonitis associated with anticancer therapy. We conducted a multicenter, single-arm trial to evaluate the safety and efficacy of durvalumab plus etoposide and carboplatin for patients with ES-SCLC and mild IIP.

Methods

Eligible patients were those who had not been previously treated with ES-SCLC and mild IIPs. Mild IIP was defined as predicted vital capacity (VC) ≥80%; no collagen vascular disease-associated antibodies; and chest high-resolution computed tomography image revealed a probable UIP, indeterminate for UIP, or alternative diagnosis pattern. The primary endpoint was severe-pneumonitis-free (SPF) rate, which was defined as the rate of patients who did not develop Grade 3 or higher pneumonitis. The study treatment was feasible if the SPF rate was 90% or more, and grade 5 pneumonitis was found within one patient.

Results

In total, 22 cases were enrolled, and 21 were included in the analysis. The median age was 74 years (range, 65–82). Most patients had stage Ⅳ disease (90%) and Eastern Cooperative Oncology Group Performance Status of 1 (67%). The median %VC was 96.1% (range 81.3–117.8). Thirteen patients displayed a probable UIP pattern, while 8 were indeterminate for UIP pattern. The SPF rate was 95.2% (20/21). The incidence of pneumonitis was 9.5% (2/21) for all grades. One patient had grade 5 pneumonitis.

Conclusions

Durvalumab plus etoposide and carboplatin can be a feasible treatment option for patients with ES-SCLC and mild IIPs.

Clinical trial identification

The Japan Registry of Clinical Trials: jRCTs051200109.

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

AstraZeneca PLC.

Disclosure

All authors have declared no conflicts of interest.