Abstract 1241P
Background
Durvalumab, an anti-PD-L1 agent, is approved for use as an adjuvant treatment of patients with stage III NSCLC previously treated with concurrent chemoradiotherapy scheduled as two-weekly infusions for one year. The COVID-19 pandemic has necessitated a move to remote monitoring of patients via telephone consultations, and a need to reduce hospital visits for patient treatment. It is however, imperative that drug safety is not compromised.
Methods
We carried out a retrospective study of 40 patients treated with 2 weekly infusions of durvalumab at The Royal Marsden Hospital between November 2018 and March 2020, prior to the COVID-19 pandemic. A total of 216 hospital visits were analysed. The number of adverse events requiring investigation or intervention were reviewed and the clinical consult documentation analysed.
Results
All 40 patients included in the study were diagnosed with Stage III NSCLC (adenocarcinoma 25/40, squamous 9/40, other 6/40) and were previously treated with chemoradiotherapy. The median number of hospital visits analysed per patient was 5. An adverse event leading to a medical intervention (concomitant medication commenced or altered, further unplanned imaging booked, referral to a non-oncology specialist) occurred in 24 out of 216 (11.1%) hospital visits. We observed a clinically significant abnormal blood test result in 8/216 (3.7%) visits. In 10/216 (4.6%) visits, durvalumab was either discontinued due to significant toxicity (5/10) or due to disease progression (5/10). On review of the doctors documentation from each clinic visit we assessed that the majority 184/216 (85.2%) of face-to-face consultations could have been safely performed via telephone with signs and symptoms elicited via verbal conversation rather than clinical examination.
Conclusions
In conclusion, patients receiving two weekly durvalumab can safely be assessed via a telephone consultation with a face-to-face consultation and blood test required in a minority of patients. Given our findings, we have now moved to 4 weekly infusions of durvalumab as permitted during the COVID-19 pandemic without a mid-cycle consultation or blood test, thereby minimising the number of hospital visits for patients with cancer.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The Royal Marsden NHS Foundation Trust.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.