Abstract 1183P
Background
In Chile, lung cancer is the second leading cause of cancer-related death. Most diagnoses are made in an advanced stage, with one third of all NSCLC cases in stage III unresectable disease, with a 5-year OS of 15%. The current standard of care for these patients has been platinum-based doublets with concurrent radiation therapy in combination with immunotherapy (IO).
Methods
We have performed a retrospective review over 517 clinical records of patients who were treated between 2014 – 2019 at “Instituto Nacional del Tórax”. Baseline clinical characteristics as well as therapy indicated and toxicity were recorded. Outcomes were analyzed by measuring progression free and overall survival. Toxicity was assessed by CTACAE v5.0 and response to treatment by RECIST 1.1 criteria.
Results
54% of the patients were men. 68% were in ECOG 0 performance status and 32% in ECOG 1, with a mean BMI of 26 kg/m2. All patients were smokers and 71% had some comorbidity in their medical history. 74% of NSCLC were adenocarcinomas and 26% squamous cell variant. 23% were stage IIIA, 54% IIIB, and 23% IIIC. Only 6 patients received adjuvant treatment before progressing to stage III disease. 86% received cisplatin (median 54.4 mg, range 40 to 60 mg) as a single dose combined with standard radiotherapy of 60 Gy averaged in 30 fractions in a concurrent modality in 91% of cases. 50% received durvalumab as maintenance. G3 toxicities were reported in 19.4%, corresponding to nausea and actinic pneumonitis. G2 toxicities were 37.1% for actinic pneumonitis and 11.4% for esophagitis. No grade 4 and 5 toxicities were reported. 82.8% progressed at 15 months on average and 17% maintained stable disease. The ORR was 77.1% among responders, the mOS was 23 months (95% CI [3.21-16.7]), and the mPFS was 10 months (95% CI [8.25- 11.75]).
Conclusions
Management of locally advance unresectable NSCLC has been changed since PACIFIC trial was published. Unfortunately, Public Health Insurance Systems does not cover access for IO. This local study was an attempt to demonstrate that classic concurrent CRT in medium-income countries could still have a relevant role in management.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
S. María Paz: Financial Interests, Personal and Institutional, Advisory Board: AstraZeneca; Financial Interests, Personal, Invited Speaker: Roche. F. Orlandi: Financial Interests, Personal, Speaker’s Bureau: AstraZeneca; Financial Interests, Personal, Speaker’s Bureau: BMS; Financial Interests, Personal, Speaker’s Bureau: Eli Lilly; Financial Interests, Personal, Speaker’s Bureau: MSD; Financial Interests, Personal, Speaker’s Bureau: Pfizer; Financial Interests, Personal, Speaker’s Bureau: Sanofi; Financial Interests, Personal and Institutional, Research Grant: Amgen; Financial Interests, Personal and Institutional, Research Grant: Astellas Pharma; Financial Interests, Personal and Institutional, Research Grant: AstraZeneca; Financial Interests, Personal and Institutional, Research Grant: BMS; Financial Interests, Personal and Institutional, Research Grant: MSD; Financial Interests, Personal and Institutional, Research Grant: Pfizer; Financial Interests, Personal and Institutional, Research Grant: Roche; Financial Interests, Personal and Institutional, Research Grant: Sanofi. All other authors have declared no conflicts of interest.