Impact of Lymphopenia Recovery After Chemoradiotherapy on Durvalumab Consolidation Therapy in Stage III NSCLC

Tomoki Kuge, MD; Takayuki Shiroyama, MD, PhD; Akihiro Tamiya, MD; Motohiro Tamiya, MD; Masaki Kanazu, MD; Yuhei Kinehara, MD, PhD; Tsunehiro Tanaka, MD; Osamu Morimura, MD, PhD; Yoshihiko Taniguchi, MD; Toshie Niki, MD, PhD; Satoshi Tetsumoto, MD, PhD; Kazuhiko Hayashi, MD, PhD; Kazumi Nishino, MD, PhD; Izumi Nagatomo, MD, PhD; Atsushi Kumanogoh, MD, PhD

JTO Clinical and Research Reports (May 2023)

Impact of Lymphopenia Recovery After Chemoradiotherapy on Durvalumab Consolidation Therapy in Stage III NSCLC

Tomoki Kuge, MD,
Takayuki Shiroyama, MD, PhD,
Akihiro Tamiya, MD,
Motohiro Tamiya, MD,
Masaki Kanazu, MD,
Yuhei Kinehara, MD, PhD,
Tsunehiro Tanaka, MD,
Osamu Morimura, MD, PhD,
Yoshihiko Taniguchi, MD,
Toshie Niki, MD, PhD,
Satoshi Tetsumoto, MD, PhD,
Kazuhiko Hayashi, MD, PhD,
Kazumi Nishino, MD, PhD,
Izumi Nagatomo, MD, PhD,
Atsushi Kumanogoh, MD, PhD

Affiliations

Tomoki Kuge, MD: Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
Takayuki Shiroyama, MD, PhD: Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan; Corresponding author. Address for correspondence: Takayuki Shiroyama, MD, PhD, Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka 565-0871, Japan.
Akihiro Tamiya, MD: Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
Motohiro Tamiya, MD: Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
Masaki Kanazu, MD: Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
Yuhei Kinehara, MD, PhD: Department of Respiratory Medicine and Clinical Immunology, Nippon Life Hospital, Osaka, Japan
Tsunehiro Tanaka, MD: Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
Osamu Morimura, MD, PhD: Department of Internal Medicine, Toyonaka Municipal Hospital, Osaka, Japan
Yoshihiko Taniguchi, MD: Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
Toshie Niki, MD, PhD: Department of Respiratory Medicine, Nishinomiya Municipal Central Hospital, Hyogo, Japan
Satoshi Tetsumoto, MD, PhD: Department of Respiratory Medicine and Clinical Immunology, Suita Municipal Hospital, Osaka, Japan
Kazuhiko Hayashi, MD, PhD: Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
Kazumi Nishino, MD, PhD: Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
Izumi Nagatomo, MD, PhD: Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
Atsushi Kumanogoh, MD, PhD: Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Immunopathology, World Premier International (WPI), Immunology Frontier Research Center (iFReC), Osaka University, Osaka, Japan; Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Osaka, Japan; Center for Infectious Diseases for Education and Research (CiDER), Osaka University, Suita, Osaka, Japan; Japan Agency for Medical Research and Development – Core Research for Evolutional Science and Technology (AMED–CREST), Osaka University, Osaka, Japan; Center for Advanced Modalities and DDS (CAMaD), Osaka University, Osaka, Japan

Journal volume & issue: Vol. 4, no. 5
p. 100505

Abstract

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Introduction: Durvalumab maintenance therapy after definitive concurrent chemoradiotherapy (CRT) is the standard treatment modality for stage III NSCLC. Although severe treatment-related lymphopenia (TRL) during CRT may impair the efficacy of subsequent durvalumab therapy, data on the effect of TRL recovery on consolidation durvalumab therapy are lacking. Methods: This retrospective study evaluated patients with unresectable stage III NSCLC treated with durvalumab after concurrent CRT. The patients were enrolled across nine institutes throughout Japan between August 2018 and March 2020. The effect of TRL recovery on survival was evaluated. The patients were divided into two groups on the basis of their lymphocyte recovery status: the recovery group involved patients who did not experience severe TRL or experienced TRL but exhibited lymphocyte count recovery at durvalumab initiation, and the nonrecovery group involved patients who experienced severe TRL and did not exhibit lymphocyte count recovery on durvalumab initiation. Results: Among the 151 patients evaluated, 41 (27%) and 110 (73%) patients were classified into the recovery and the nonrecovery groups, respectively. The nonrecovery group had significantly worse progression-free survival than the recovery group (21.9 mo versus not reached, p = 0.018). Recovery from TRL (p = 0.027) and high pre-CRT lymphocyte count (p = 0.028) independently influenced progression-free survival. Conclusions: Baseline lymphocyte count and recovery from TRL at the start of durvalumab therapy were predictive factors for survival outcomes in patients with NSCLC treated with durvalumab consolidation after concurrent CRT.

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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