Abstract 1247P
Background
In patients with unresectable stage III NSCLC, consolidative durvalumab has been shown to improve both PFS and OS following concurrent chemoradiotherapy. We performed a retrospective review to better understand patterns of practice and patient outcomes in British Columbia.
Methods
A review was conducted of unresectable stage III NSCLC patients treated with chemoradiotherapy between March 2018 and June 2019, after durvalumab was provincially available. Patient demographics, histology, ECOG, smoking status, PD-L1 status, sites of first progression and treatment toxicity were collected. Reason for omission of durvalumab per physician’s documentation was recorded.
Results
196 patients were identified. Baseline characteristics were median age 67, male 51%, 69% non-squamous histology, 18% PD-L1<1%/14% PD-L1 1-49%/24% PD-L1 ≥50%/43% unknown. Median radiotherapy dose was 60 Gy, 38% received cisplatin, 62% carboplatin; 49% durvalumab. Median time to starting durvalumab after chemoradiotherapy was 43 days, median treatment completed was 18 cycles, 22 patients remain on durvalumab. Of 99 patients who did not receive durvalumab, 35% no documentation from physician, 21% patient preference, 8% poor ECOG, 4% residual toxicity from chemoradiotherapy, 4% physician preference, 1% autoimmune disease. 71 untreated patients were medically eligible for durvalumab (36% of total). Median follow-up was 18.2 months. 1-year PFS was 75% durvalumab vs 51% surveillance (HR 0.39, 95% CI 0.26-0.58, p<0.001). Sites of first progression were intrathoracic 16% durvalumab vs 26% surveillance, extrathoracic 14% durvalumab vs 26% surveillance. 1-year OS was 91% durvalumab vs 72% surveillance (HR 0.42, 95% CI 0.25-0.71, p=0.001). Durvalumab was well tolerated, with 20% all-grade pneumonitis (5% incidence of grade 3 pneumonitis).
Conclusions
In a real-world population, durvalumab is associated with higher OS in patients with unresectable stage III NSCLC following concurrent chemoradiotherapy. Thirty six percent of patients who were medically eligible did not receive durvalumab, predominantly due to physician decision and patient preference. The benefits of consolidation durvalumab should be well communicated to patients to improve their chance of cure.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
C. Ho: Advisory/Consultancy, Speaker Bureau/Expert testimony: AstraZeneca; Advisory/Consultancy: Boehringer Ingleheim; Advisory/Consultancy: Bristol-Myers Squibb; Advisory/Consultancy: Merck; Advisory/Consultancy, Travel/Accommodation/Expenses: Roche; Advisory/Consultancy, Speaker Bureau/Expert testimony: Eisai; Advisory/Consultancy: Novartis; Advisory/Consultancy: Bayer; Speaker Bureau/Expert testimony: Genzyme. E. Berthelet: Honoraria (self), Speaker Bureau/Expert testimony: Genzyme; Honoraria (self), Speaker Bureau/Expert testimony: Eisai. J. Laskin: Honoraria (self): Boehringer Ingelheim; Honoraria (self), Speaker Bureau/Expert testimony: Roche; Honoraria (self), Speaker Bureau/Expert testimony: AstraZeneca; Honoraria (self): Pfizer. S. Sun: Honoraria (self): AstraZeneca; Honoraria (self): Bristol-Myers Squibb. B. Melosky: Advisory/Consultancy: Boehringer Ingelheim; Advisory/Consultancy: Bristol-Myers Squibb; Advisory/Consultancy: Merck; Advisory/Consultancy: Pfizer; Advisory/Consultancy, Travel/Accommodation/Expenses: Roche. All other authors have declared no conflicts of interest.