Dutch study highlights ‘unmet needs’ of patients with NSCLC following PACIFIC trial
Click Here to Manage Email Alerts
Concurrent chemoradiotherapy use among patients with stage III non-small cell lung cancer increased significantly following publication of the PACIFIC trial, according to a Dutch study published in JTO Clinical and Research Reports.
The PACIFIC trial showed PFS and OS improvements among this patient population with use of adjuvant durvalumab for 1 year after concurrent chemoradiotherapy (CCRT). Although most patients who underwent CCRT received adjuvant durvalumab (Imfinzi, AstraZeneca) since 2018, almost half were considered unfit for radical-intent treatment.
The study showed a “gap between guideline-recommended treatments and real-world care of these patients” and demonstrated “a timely incorporation of evidence-based medicine [is needed in] oncology practice,” Merle I. Ronden, MD, resident in the department of radiation oncology at Amsterdam University Medical Center, said in an International Association for the Study of Lung Cancer (IASLC)-issued press release.
“These findings highlight the unmet needs of patients who are unfit for radical-intent treatment [RIT],” Ronden told Healio.
Ronden and colleagues hypothesized that introducing durvalumab consolidation would trigger changes in the patterns of chemoradiotherapy in the Netherlands, with thoracic multidisciplinary tumor boards recommending CCRT over sequential chemoradiotherapy.
“As considerable variations between countries exist in patterns of care in stage III NSCLC, our aim was to identify patient factors influencing treatment decision-making by three Dutch multi-disciplinary teams,” Ronden said of identifying changes in practices when adjuvant durvalumab became available.
The analysis included 855 patients with stage III NSCLC, including 475 who presented between 2015 and 2017 and 380 who presented between 2018 and 2019. Among all patients, 95% were discussed at a multidisciplinary tumor board, and RITs — which consisted of CCRT or multimodality schemes that included surgery — were recommended for 63%.
Results showed that from 2015-2017 to 2018-2019, the proportion of patients undergoing CCRT increased from 34% to 42% (P = .02). Additionally, the use of sequential chemoradiotherapy declined over that period, from 21 % to 16% (P = .05). Rates of early toxicity and 1-year mortality were comparable in both time periods, according to researchers, but after 2018, 57% of the patients who underwent CCRT (n = 90 of 159) received adjuvant durvalumab.
“In this real-world setting, only 52% of patients with stage III NSCLC were fit to undergo RITs consisting of approaches incorporating surgery or CCRT,” Ronden told Healio, shining a light on the needs of patients unfit for RIT.
Age of 70 years or older, WHO performance score of 2 or higher, Charlson Comorbidity Index of 2 or higher (excluding age), a forced expiratory volume in 1 second of less than 80% of predicted value, N3 disease and period of diagnosis (2015-2017) all were predictors for not recommending RIT.
Ronden noted it was “reassuring” that changes in practice did not increase rates of early toxicity and mortality in the cohort. He added, however, that the research team would like to collect additional data on each as the follow-up was limited to 1 year.
“Our findings suggest that there is room for multidisciplinary teams to increase the rate of use of CCRT for stage III NSCLC,” Ronden and colleagues wrote. “The findings also highlight the need for novel clinical trials to address the unmet needs of patients who cannot receive treatment with radical intent, in an era of significant advances in systemic therapies for NSCLC.”
For more information:
Merle I. Ronden, MD, can be reached at Department of Radiation Oncology, VU University Medical Center, Amsterdam UMC, De Boelelaan 1117, Post Box 7057, 1007 MB Amsterdam, Netherlands; email: m.ronden@amsterdamumc.nl.
Collapse
Click Here to Manage Email Alerts