Adjuvant immune checkpoint inhibitor following chemoradiation in NSCLC
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Seventy-nine percent of stage III non-small cell lung cancer patients who received chemoradiation were also treated with at least one dose of adjuvant immunotherapy, according to findings presented at the virtual 2021 ASCO Annual Meeting.
“Adjuvant durvalumab was shown in the landmark PACIFIC trial to improve overall survival, when given adjuvantly among patients with stage III NSCLC treated with definitive chemoradiation,” Alex K. Bryant, MD, MAS, said in the presentation. “What we wanted to do was to investigate the real-world use of durvalumab in stage III patients in the state of Michigan and in a statewide consortium.”
Bryant and colleagues observed 450 patients with unresectable stage III NSCLC from 22 community centers (n = 378) and five academic centers (n = 72). The patients were treated with definitive radiation and concurrent chemotherapy from February 2018 to March 2020. Following the chemoradiation, patients were treated with adjuvant durvalumab or other immune checkpoint inhibitors (ICI) at 3- or 6-month follow-up.
“What we found was that patients who received adjuvant immune checkpoint inhibition, which overall accounted for 79% of the potentially eligible cohort, those patients tended to be younger,” Bryant said.
Median age was 66 years, and 85% of white patients received ICI compared with 77% of Black patients, but there were no differences in sex (54.5% men in ICI vs. 52.3% no ICI). Additionally, those who received ICI tended to have a better ECOG performance than those who did not (6% vs. 15%).
“We also saw significant heterogeneity in the percentage of potentially eligible stage III patients who received immune checkpoint inhibition,” Bryant said.
Bryant and colleagues reported that 79% of stage III NSCLC patients treated with chemoradiation received at least one dose of adjuvant immunotherapy, and rates at individual institutions ranged from 67% to 92%.
“We will attempt to determine why these 21% of potentially eligible patients did not receive any adjuvant durvalumab, whether that was patient noncompliance, loss to follow-up, patients declining, or whether they had autoimmune conditions or other conditions that would render them ineligible for immune therapy,” Bryant said. “Then we will also perform a multi-level regression to assess and control for the role of institutional variability and clustering by institution in determining the odds of receiving immune checkpoint inhibition.”
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Bryant AK, et al. Abstract 8523. Presented at: ASCO Annual Meeting; June 4-8, 2021 (virtual meeting).
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