Poor survival among patients with NSCLC who did not receive consolidation therapy
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CHICAGO — Among patients with stage III non-small cell lung cancer who completed chemoradiation, over one-quarter did not receive consolidation immune checkpoint inhibitors, according to findings presented at ASCO Annual Meeting.
Findings from the PACIFIC trial demonstrated a 10% improvement in 5-year survival with the addition of consolidation durvalumab (Imfinzi, AstraZeneca) following chemoradiation when compared with placebo. The objective of this retrospective study was to describe the real-world application of consolidation durvalumab, or other immune checkpoint inhibitors.
“We found that of patients who actually complete chemoradiation for stage III non-small cell lung cancer, about 27% don’t go on to receive consolidation durvalumab or other checkpoint inhibitors,” Nikhil Yegya-Raman, MD, radiation oncologist with University of Pennsylvania Health System, told Healio.
According to Yegya-Raman, consolidation durvalumab is more restricted in other health care systems and countries, so the rate of patients not receiving consolidation therapy is “probably higher” in these settings.
“At Penn, we do typically give it for PDL expression less than 1%, whereas that’s not always done,” he said.
The researchers included 148 consecutively treated patients with unresectable stage III NSCLC who completed chemoradiation. Of the 148, 108 (73%) received consolidation immune checkpoint inhibitors and 40 (27%) did not. Among patients who received consolidation therapy, 42% completed 1 year of treatment. According to the abstract, reasons for patients not receiving consolidation therapy included disease progression, chemoradiation toxicity, comorbidity or decline unrelated to chemoradiation, provider choice due to EGFR mutation or atypical histology, patient refusal and death without progression.
Moreover, the group receiving consolidation therapy demonstrated better performance status, lower Charlson Comorbidity Index, and lower rates of active autoimmune disease or immunosuppression. In the consolidation therapy group, the 1-year overall survival was 83% and the 2-year overall survival was 61%. Comparatively, in the group that did not receive consolidation therapy, the 1-year and 2-year overall survival rates were 52% and 34%, respectively. Furthermore, overall survival among patients with disease progression was worse compared with patients who did not have disease progression following chemoradiation.
“The bigger question is, can we potentially predict which patients might not get durvalumab or other checkpoint inhibitors due to disease progression or chemoradiation toxicity, and should we be considering different treatment paradigms for those patients?” Yegya-Raman said. “For example, the most common reason for nonreceipt of consolidation checkpoint inhibitors in our cohort was due to disease progression after chemoradiation, and most of the time it’s distant disease progression. So, that brings up the question, should we be considering earlier use, earlier integration of immunotherapy for those patients?”
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Yegya-Raman N, et al. Abstract 8523. Presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago.
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