Abstract 965P
Background
PACIFIC reported improved overall survival and acceptable toxicity of consolidation Durvalumab following CRT for pts with unresectable stage III NSCLC. However, real-world data examining efficacy and toxicity in the elderly and pts with many comorbidities is limited.
Methods
We conducted a retrospective observational study of pts treated with consolidation Durvalumab following platinum-based CRT for unresectable stage III NSCLC across 6 centres in Sydney, Australia, between January 2018 and September 2021. Pts over 70 years old were defined as elderly. High burden of comorbidity was denoted by Charlson Comorbidity Index (CCI) ≥5. The primary outcomes were toxicity and a composite of progression and death.
Results
145 pts were included and followed-up for a median of 18.9 months. Median age was 67 years and 62.8% were male. 43.8% of pts were ≥ 70 years old, 28.2% had CCI ≥5 and 95.1% were ECOG 0-1. 96.5% completed all planned radiotherapy (RT). Elderly and highly comorbid pts were statistically more likely to receive carboplatin-based chemoradiation (p=0.01 and p=0.04). 94.5% of pts experienced an adverse event (AE) during CRT and 71% experienced an AE during Durvalumab. Immune-related AEs (IRAE) of any grade were seen in 53.8% of pts and 15.1% had grade 3-4 toxicity. Pneumonitis was the most common IRAE (24.1% pts) though 77.2% of pneumonitis was confined to the RT field. 8.3% pts experienced G3-5 pneumonitis including one death. We found no association between age ≥70 and G3-4 CRT or Durvalumab toxicity, chemotherapy dose reduction, treatment delays or discontinuation, or the composite of progression and death. CCI ≥5 was associated with higher G3-4 toxicity from Durvalumab (OR 4.3, 95% CI 1.5-12.5, p=0.003) and there was a trend towards early discontinuation of Durvalumab (p=0.051).
Conclusions
This data suggests that elderly pts deemed suitable for this regimen did not suffer greater toxicity or poorer outcomes from treatment. Pts with CCI ≥5 experienced increased G3-4 toxicity from Durvalumab. Whilst prospective validation is needed, this may guide risk assessment in this population.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
A. Nagrial: Financial Interests, Personal, Advisory Board: Bristol-Myers Squibb, AstraZeneca, Roche, MSD Oncology; Financial Interests, Institutional, Funding: Bristol-Myers Squibb, MSD Oncology, AstraZeneca/MedImmune, Amgen, Akeso Biopharma. J.H. Lee: Financial Interests, Personal, Other, Honoraria: Bristol-Myers Squibb, MSD Oncology, Sanofi; Financial Interests, Personal, Advisory Board: Sanofi; Financial Interests, Personal, Funding: MSD Oncology; Financial Interests, Personal, Other, Travel, Accommodations, Expenses: Bristol-Myers Squibb; Financial Interests, Institutional, Other, Travel, Accommodations, Expenses: Novartis. M. Boyer: Financial Interests, Institutional, Advisory Board: Merck Sharp & Dohme, AstraZeneca, Bristol-Myers Squibb, Janssen; Financial Interests, Personal, Other, Honoraria: AstraZeneca, CancerAid; Financial Interests, Institutional, Research Grant: Merck Sharp & Dohme, Pfizer, Boehringer Ingelheim, Lilly, Genentech/Roche, AstraZeneca, Bristol-Myers Squibb, Amgen, Ascentage Pharma, Novartis, Janssen, Merck Serono, Imugene, Nektar. S.C. Kao: Financial Interests, Personal, Other, Travel, Accommodations, Expenses: Boehringer Ingelheim, Roche, Bristol-Myers Squibb; Financial Interests, Institutional, Other, Honoraria: Pfizer, AstraZeneca, Roche, Bristol-Myers Squibb, MSD Oncology, Takeda, Boehringer Ingelheim; Financial Interests, Institutional, Research Grant: AstraZeneca. All other authors have declared no conflicts of interest.