Abstract 1248P
Background
The role of immune checkpoint inhibitors (ICI) administered concurrent with or after definitive chemoradiation (CRT) in stage III non-small cell lung cancer (NSCLC) have been detailed in several recent and ongoing studies. We performed a systematic review to determine the rates of pneumonitis as well as the efficacy of ICI with CRT.
Methods
A structured search of the MEDLINE Ovid® and EMBASE Ovid® databases was performed using keywords and MeSH terms, in addition to snowballing using manual bibliography searches. Studies that used anti PD-1 or anti PD-L1 therapy, either sequentially (S) or concurrently (C) with CRT, for patients (pts) with stage III NSCLC were included. A qualitative and descriptive analysis of overall survival (OS), progression free survival (PFS) and safety at 12 months was performed when applicable. A meta-analysis of pneumonitis rates was performed based on weighted pooled proportion, using random-effects models. Chi squared tests were used to study heterogeneity between studies.
Results
A total of 12 studies (7 clinical trials and 5 real-world reports, n= 1295 pts) were identified. There were 8 studies that examined sequential anti PD-1 or anti PD-L1 therapy after CRT, 2 studies examined concurrent ICI and 2 investigated both approaches. There were 2 studies that reported mutation status, and 5 that reported PD-L1 status. The pooled rates of ≥ G3 pneumonitis were 8.3% (95% CI 5.6%-12.1%) in C vs 7.0% (95% CI 4.0%-11.9%) in S. The rates of ≥ G3 pneumonitis were similar between patients receiving anti PD-L1 (6.1%, 95% CI 2.9%-12.4%) and anti PD-1 (8.7%, 95% CI 6.3%-11.9%) therapy. A sensitivity analysis performed excluding the PACIFIC study showed rates of ≥ grade 3 pneumonitis to be 9.3% (95% CI 6.9%-12.3%) for all patients receiving ICI with CRT. Treatment related deaths were 1.4% (95% CI 0.3%-6.7%) in C vs 2.1% (95% CI 1.1%-3.4%) in S. Mean weighted OS at 12 and 24 months was 82.7% and 65.6% respectively.
Conclusions
Concurrent vs sequential ICI is associated with similar rates of pneumonitis. We did not observe any differences between PD-1 or PD-L1 inhibitors regardless of whether the treatment was given concurrently or sequentially after CRT.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Adithya Balasubramanian.
Funding
Has not received any funding.
Disclosure
A. Balasubramanian: Travel/Accommodation/Expenses: Novartis. A. Gunjur: Honoraria (self): Bristol-Myers Squibb. T. John: Honoraria (self), Advisory/Consultancy: AstraZeneca; Honoraria (self), Advisory/Consultancy: Boehringer Ingelheim; Honoraria (self), Advisory/Consultancy: Bristol-Myers Squibb; Honoraria (self), Advisory/Consultancy: Ignyta; Honoraria (self), Advisory/Consultancy: Merck; Honoraria (self), Advisory/Consultancy: MSD Brazil; Honoraria (self), Advisory/Consultancy: Novartis Pharma SAS; Honoraria (self), Advisory/Consultancy: Pfizer Pharmaceuticals Israel; Honoraria (self), Advisory/Consultancy: Roche; Honoraria (self), Advisory/Consultancy: Takeda. S. Parakh: Travel/Accommodation/Expenses: AstraZeneca. All other authors have declared no conflicts of interest.