Abstract 145P
Background
Standard therapy for unresectable LA-NSCLC is concurrent RT-ChT followed by durvalumab according PACIFIC trial. PACIFIC 6 trial showed benefit of durvalumab after sequential ChT-RT. Recent trial reported benefit adding immunotherapy to SAbR in early-stage NSCLC. This is the first trial (NCT05291780) evaluating of curative SAbR in unresectable LA-NSCLC patients receiving durvalumab (1). Here we report the efficacy and safety of i(immunotherapy)-SAbR in LA-NSCLC patients treated with radical-intent based on PACIFIC trial.
Methods
Between December 31, 2015 and December 31, 2023 93 LA-NSCLC patients were enrolled. 51 (55%) fit patients received neoadjuvant ChT and 18 (20%) PD-L1 ≥1% received Durvalumab. The tumor volume included primary tumor (T) and any regionally positive node/s (N). The co-primary study endpoints were LC and safety. The co-secondary endpoints were disease free survival (DFS) and overall survival (OS).
Results
Median age was 71 years (52-78), adenocarcinoma (ADC) and squamous cell carcinoma (SCC) in 11 (61%) and 7 (39%). IIIA, IIIB and IIIC in 8 (44%), 6(33%) and 4(22%) patients. Median dose was 45Gy(40-60) and 40Gy(35-50) in 5 fx to T and N, respectively. The median time between SAbR and durvalumab was 14d(8-20). After median follow-up of 36 months (6-62), 4(22%) patients had LR. The median LR-free survival (FS) was NR (95% CI, 27 to -). The 1-, 2- and 3- year LR-FS were 94%, 81% and 50%. 3 (16%) had regional recurrence (rR). The median rR-FS was NR (95% CI, 27 to -). The 1-, 2- and 3- year rR-FS rates were 94%, 81% and 69%. 7(39%) patients had distant progression (dP). The median dP-FS was NR (95% CI, 14 to -). The 1-, 2- and 3- year dP-FS rates were 100%,55% and 55%. Median DFS was 24 months (95% CI,14-34). The 1-, 2- and 3- year DFS rates were 94%, 45% and 17%. Median OS was NR (95% CI, 31 to -). The 1, 2, and 3-year OS rates were 88%,82% and 68%. 3(16%) discontinued Durvalumab due to lung and esophageal G3 toxicity.
Conclusions
LA-NSCLC patients treated with i-SAbR had optimal LC and promising OS with low rate of G3 toxicity. Our early outcomes would suggest the feasibility of using durvalumab following SAbR in LA-NSCLC patients unfit for concurrent ChT-RT.
1. Int J Radiat Oncol Biol Phys. 2023 Mar 15;115(4):886-896.
Clinical trial identification
NCT05291780.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.