Abstract 199P
Background
Locally advanced unresectable non-small cell lung cancer can be managed with chemoradiation therapy followed by consolidative PDL1 immunotherapy (I/O). In a real-world cohort, we sought to evaluate the toxicity profiles and responses of vs chemoradiation alone vs chemoradiation followed by consolidative immunotherapy vs concurrent I/O during chemoradiation + consolidative I/O.
Methods
We retrospectively reviewed an IRB approved institutional database of patients with locally advanced unresectable NSCLC. Charts were reviewed for cancer stage, histology, demographics, response, acute and subacute toxicities. Rates of toxicity were evaluated using CTCAE v5.0 grading.
Results
A total of 103 patients were included. Ages ranged from 43–85 years and 65% male. 93% of patients had ECOG PS 0–1; 7% ECOG PS of 2. Adenocarcinoma histology was present in 59%, squamous cell carcinoma 34%, non-small cell carcinoma NOS 7%. Stage III patients comprised 83% of patients, 11% Stage II, and 6% oligometastatic Stage IV. Median radiation dose was 60 Gy (range, 40–64 Gy) delivered with weekly carboplatin and paclitaxel in 93% of cases. Chemoradiation alone was given in 34 patients, 13 received concurrent + consolidation I/O, and 56 received consolidation I/O. Grade 2 pneumonitis occurred 18% in the chemoradiation alone group, 23% in the concurrent + consolidation I/O group, 16% in the consolidation I/O group. Grade 3 pneumonitis occurred in 4% of patients in the consolidation I/O group, but in no patients in the chemoradiation alone or concurrent + consolidation I/O groups. Grade 3 esophagitis occurred in 3% of patients among the entire cohort. 49% of patients had a partial response, 41% had stable disease, 2% had complete response, and 8% had disease progression, and no patients progressed in the concurrent I/O group.
Conclusions
Modern concurrent chemoradiation therapy with or without PD(L)1 immunotherapy is very well tolerated with primarily grade 2 toxicities of esophagitis and pneumonitis and overall excellent response rates. Chemoradiation remains an appropriate and effective standard of care therapy for patients with locally advanced and unresectable non-small cell lung cancer.
Legal entity responsible for the study
S. Jabbour.
Funding
Has not received any funding.
Disclosure
S. Jabbour: Financial Interests, Personal, Advisory Role: JNJ; Financial Interests, Personal and Institutional, Principal Investigator: Merck; Financial Interests, Institutional, Research Grant: BeiGene; Financial Interests, Personal, Expert Testimony: Deichert; Non-Financial Interests, Institutional, Research Grant: Guardant. All other authors have declared no conflicts of interest.