Concurrent Chemoradiation With or Without Durvalumab in Elderly Patients With Unresectable Stage III NSCLC: Safety and Efficacy

Sally C.M. Lau, MD, MPH; Malcolm Ryan, BSc; Jessica Weiss, PhD; Aline Fusco Fares, MD; Miguel Garcia, MD; Sabine Schmid, MD; Shelley Kuang, MD; Deirdre Kelly, MB BCh BAO; Ming Sound Tsao, MD; Penelope A. Bradbury, MB BCh; Byoung Chun J. Cho, MD; Alexander Sun, MD; Srinivas Raman, MD; Andrew Hope, MD; Meredith Giuliani, MBBS, MEd, PhD; Benjamin H. Lok, MD, PhD; Andrea Bezjak, MD; Geoffrey Liu, MD, MSc; Natasha B. Leighl, MD, MSc; Frances A. Shepherd, MD; Adrian G. Sacher, MD, MMSc

JTO Clinical and Research Reports (Dec 2021)

Concurrent Chemoradiation With or Without Durvalumab in Elderly Patients With Unresectable Stage III NSCLC: Safety and Efficacy

Sally C.M. Lau, MD, MPH,
Malcolm Ryan, BSc,
Jessica Weiss, PhD,
Aline Fusco Fares, MD,
Miguel Garcia, MD,
Sabine Schmid, MD,
Shelley Kuang, MD,
Deirdre Kelly, MB BCh BAO,
Ming Sound Tsao, MD,
Penelope A. Bradbury, MB BCh,
Byoung Chun J. Cho, MD,
Alexander Sun, MD,
Srinivas Raman, MD,
Andrew Hope, MD,
Meredith Giuliani, MBBS, MEd, PhD,
Benjamin H. Lok, MD, PhD,
Andrea Bezjak, MD,
Geoffrey Liu, MD, MSc,
Natasha B. Leighl, MD, MSc,
Frances A. Shepherd, MD,
Adrian G. Sacher, MD, MMSc

Affiliations

Sally C.M. Lau, MD, MPH: Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
Malcolm Ryan, BSc: Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
Jessica Weiss, PhD: Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
Aline Fusco Fares, MD: Department of Medical Oncology, Faculty of Medicine, Hospital de Base de São José do Rio Preto, Sao Paulo, Brazil
Miguel Garcia, MD: Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
Sabine Schmid, MD: Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
Shelley Kuang, MD: Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
Deirdre Kelly, MB BCh BAO: Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
Ming Sound Tsao, MD: Department of Pathology, Laboratory Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
Penelope A. Bradbury, MB BCh: Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
Byoung Chun J. Cho, MD: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
Alexander Sun, MD: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
Srinivas Raman, MD: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
Andrew Hope, MD: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
Meredith Giuliani, MBBS, MEd, PhD: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
Benjamin H. Lok, MD, PhD: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada
Andrea Bezjak, MD: Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
Geoffrey Liu, MD, MSc: Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
Natasha B. Leighl, MD, MSc: Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
Frances A. Shepherd, MD: Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada
Adrian G. Sacher, MD, MMSc: Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Canada; Corresponding author. Address for correspondence: Adrian G Sacher, MD, Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 610 University Avenue, Toronto ON M5G 2M9, Canada.

Journal volume & issue: Vol. 2, no. 12
p. 100251

Abstract

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Introduction: The addition of durvalumab after chemoradiation therapy (CRT) in unresectable stage III NSCLC significantly improves survival. The benefit of this approach in elderly patients is controversial given the toxicity associated with CRT and, thus, may be underutilized. We sought to investigate the outcomes of elderly patients treated with CRT without or without durvalumab at our center. Methods: We reviewed all stage III patients with NSCLC treated with CRT between 2018 and 2020. Patients were analyzed on the basis of age: less than 70 years and 70 years and older. The end points evaluated were treatment patterns, toxicity, progression-free survival, and overall survival. Results: The baseline characteristics including Eastern Cooperative Oncology Group performance status and comorbidities were similar among the 115 patients (44 elderly, 71 young). Completion rates of CRT (100%, 97%) and chemotherapy dose intensity (97%, 97%) were high in elderly and young patients, respectively. There was a trend toward increased hospitalizations in elderly patients because of infections (27% versus 13%, p = 0.08). Of those who did not have primary progression after CRT, 78% of eldery and 81% of young patients received durvalumab. The incidence of grade 3 or higher immune-related adverse events was 9% in elderly and 6% in young patients (p = 0.67). The median progression-free survival was similar (15.6 versus 10.5 mo, p = 0.10), even after adjusting for comorbidities (hazard ratio = 0.6, p = 0.09). The 12-month overall survival rates were 78% in the elderly and 76% in young patients (p = 0.98). Conclusions: Well-selected elderly patients can be treated safely with CRT followed by durvalumab with similar survival benefits compared with their younger counterparts. We would advocate for the referral of all elderly patients for oncologic assessment to avoid undertreatment.

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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