Pneumonitis in Patients Receiving Thoracic Radiotherapy and Osimertinib: A Multi-Institutional Study

Leou Ismael Banla, MD, PhD; Alice Tzeng, MD, PhD; John P. Baillieul; Melin J. Kandekhar, MD, PhD; Kelly J. Fitzgerald, MD, PhD; Jaclyn LoPiccolo, MD, PhD; Holly A. Poitras; Daniel E. Soto, MD; Julia K. Rotow, MD; Lisa Singer, MD, PhD; Henning Willers, MD; David E. Kozono, MD, PhD; Pasi A. Janne, MD, PhD; Raymond H. Mak, MD; Zofia Piotrowska, MD; Florence K. Keane, MD; Benjamin H. Kann, MD

JTO Clinical and Research Reports (Oct 2023)

Pneumonitis in Patients Receiving Thoracic Radiotherapy and Osimertinib: A Multi-Institutional Study

Leou Ismael Banla, MD, PhD,
Alice Tzeng, MD, PhD,
John P. Baillieul,
Melin J. Kandekhar, MD, PhD,
Kelly J. Fitzgerald, MD, PhD,
Jaclyn LoPiccolo, MD, PhD,
Holly A. Poitras,
Daniel E. Soto, MD,
Julia K. Rotow, MD,
Lisa Singer, MD, PhD,
Henning Willers, MD,
David E. Kozono, MD, PhD,
Pasi A. Janne, MD, PhD,
Raymond H. Mak, MD,
Zofia Piotrowska, MD,
Florence K. Keane, MD,
Benjamin H. Kann, MD

Affiliations

Leou Ismael Banla, MD, PhD: Harvard Radiation Oncology Program, Boston, Massachusetts
Alice Tzeng, MD, PhD: Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
John P. Baillieul: Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
Melin J. Kandekhar, MD, PhD: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Kelly J. Fitzgerald, MD, PhD: Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
Jaclyn LoPiccolo, MD, PhD: Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
Holly A. Poitras: Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
Daniel E. Soto, MD: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Julia K. Rotow, MD: Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
Lisa Singer, MD, PhD: Department of Radiation Oncology, University of California San Francisco, San Francisco, California
Henning Willers, MD: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
David E. Kozono, MD, PhD: Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
Pasi A. Janne, MD, PhD: Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
Raymond H. Mak, MD: Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
Zofia Piotrowska, MD: Department of Medicine, Division of Hematology/ Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Florence K. Keane, MD: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Benjamin H. Kann, MD: Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts; Corresponding author. Address for correspondence: Benjamin Kann, MD, Department of Radiation Oncology, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115.

Journal volume & issue: Vol. 4, no. 10
p. 100559

Abstract

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Introduction: Thoracic radiotherapy (TRT) is increasingly used in patients receiving osimertinib for advanced NSCLC, and the risk of pneumonitis is not established. We investigated the risk of pneumonitis and potential risk factors in this population. Methods: We performed a multi-institutional retrospective analysis of patients under active treatment with osimertinib who received TRT between April 2016 and July 2022 at two institutions. Clinical characteristics, including whether osimertinib was held during TRT and pneumonitis incidence and grade (Common Terminology Criteria for Adverse Events version 5.0) were documented. Logistic regression analysis was performed to identify risk factors associated with grade 2 or higher (2+) pneumonitis. Results: The median follow-up was 10.2 months (range: 1.9–53.2). Of 102 patients, 14 (13.7%) developed grade 2+ pneumonitis, with a median time to pneumonitis of 3.2 months (range: 1.5–6.3). Pneumonitis risk was not significantly increased in patients who continued osimertinib during TRT compared with patients who held osimertinib during TRT (9.1% versus 15.0%, p = 0.729). Three patients (2.9%) had grade 3 pneumonitis, none had grade 4, and two patients had grade 5 events (2.0%, diagnosed 3.2 mo and 4.4 mo post-TRT). Mean lung dose was associated with the development of grade 2+ pneumonitis in multivariate analysis (OR = 1.19, p = 0.021). Conclusions: Although the overall rate of pneumonitis in patients receiving TRT and osimertinib was relatively low, there was a small risk of severe toxicity. The mean lung dose was associated with an increased risk of developing pneumonitis. These findings inform decision-making for patients and providers.

Published in JTO Clinical and Research Reports

ISSN: 2666-3643 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jto-clinical-and-research-reports/

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