Impact of interstitial lung abnormality on survival after adjuvant durvalumab with chemoradiotherapy for locally advanced non-small cell lung cancer

Introduction: Concurrent chemoradiotherapy (CCRT) has been the standard of care for patients with locally advanced non-small cell lung cancer (LA-NSCLC). Background and Purpose: The results of the PACIFIC trial established the use of consolidative durvalumab after concurrent chemoradiotherapy (CCRT) as the standard of care for patients with locally advanced non-small cell lung cancer (LA-NSCLC). A subgroup analysis of the PACIFIC trial reported a better progression-free survival (PFS) in Asians. Although real-world data on LA-NSCLC patients who received CCRT plus durvalumab have been reported, there have been few large-scale reports on Asians. In this study, we investigated prognostic factors in the largest real-world data set in Asia of only Japanese LA-NSCLC patients treated with CCRT plus durvalumab. Materials and Methods: One hundred and thirteen LA-NSCLC patients who received definitive CCRT and consolidative durvalumab at our institution between May 2018 and April 2021 were analyzed. Overall survival (OS), cause-specific survival (CSS), PFS, distant metastasis-free survival (DMFS), and in-field progression-free survival (IFPFS) were investigated as treatment outcomes using competing risk analyses. Results: During a median follow-up of 24 months (range, 5-47) after the initiation of durvalumab ther-apy, 31 patients died, of whom 23 died of lung cancer. In the multivariate analysis, the pretreatment fac-tors that correlated with OS were ILA scores, adenocarcinoma, and performance status at the initiation of durvalumab. Furthermore, ILA score and programmed cell death ligand 1 (PD-L1) tumor proportion score (TPS) >= 1 % were significantly correlated with CSS, and PD-L1 TPS >= 1 % was significantly correlated with PFS and IFPFS. Conclusion: Pretreatment ILA, adenocarcinoma, and performance status may have an impact on OS of LA-NSCLC patients receiving CCRT plus durvalumab. (c) 2022 The Author(s). Published by Elsevier B.V. Radiotherapy and Oncology xxx (2023) xxx-xxx This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Automated summary

This study investigated the prognostic factors of LA-NSCLC patients treated with CCRT plus durvalumab in Japan, and found that pretreatment factors such as ILA, adenocarcinoma, and performance status were correlated with overall survival. PD-L1 expression and ILA score were significantly correlated with cause-specific survival, progression-free survival, and in-field progression-free survival.