Pneumonitis During Durvalumab Consolidation Therapy Affects Survival in Stage III NSCLC

Yuhei Kinehara, MD, PhD; Takayuki Shiroyama, MD, PhD; Akihiro Tamiya, MD; Motohiro Tamiya, MD; Seigo Minami, MD, PhD; Masaki Kanazu, MD; Osamu Morimura, MD, PhD; Toshie Niki, MD, PhD; Satoshi Tetsumoto, MD, PhD; Yoshihiko Taniguchi, MD; Tomoki Kuge, MD; Kazumi Nishino, MD, PhD; Izumi Nagatomo, MD, PhD; Atsushi Kumanogoh, MD, PhD; Isao Tachibana, MD, PhD

JTO Clinical and Research Reports (Nov 2023)

Pneumonitis During Durvalumab Consolidation Therapy Affects Survival in Stage III NSCLC

Yuhei Kinehara, MD, PhD,
Takayuki Shiroyama, MD, PhD,
Akihiro Tamiya, MD,
Motohiro Tamiya, MD,
Seigo Minami, MD, PhD,
Masaki Kanazu, MD,
Osamu Morimura, MD, PhD,
Toshie Niki, MD, PhD,
Satoshi Tetsumoto, MD, PhD,
Yoshihiko Taniguchi, MD,
Tomoki Kuge, MD,
Kazumi Nishino, MD, PhD,
Izumi Nagatomo, MD, PhD,
Atsushi Kumanogoh, MD, PhD,
Isao Tachibana, MD, PhD

Affiliations

Yuhei Kinehara, MD, PhD: Department of Respiratory Medicine and Clinical Immunology, Nippon Life Hospital, 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
Seigo Minami, MD, PhD: Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan
Masaki Kanazu, MD: Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
Osamu Morimura, MD, PhD: Department of Respiratory Medicine, Toyonaka Municipal Hospital, 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
Yoshihiko Taniguchi, MD: Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
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
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, 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
Isao Tachibana, MD, PhD: Department of Respiratory Medicine and Clinical Immunology, Nippon Life Hospital, Osaka, Japan

Journal volume & issue: Vol. 4, no. 11
p. 100586

Abstract

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Introduction: Durvalumab consolidation therapy is the standard of care after concurrent chemoradiotherapy (CRT) for stage III NSCLC. Immune-related pneumonitis during durvalumab treatment is potentially fatal; however, information is lacking regarding the impact of pneumonitis on patient survival. This study investigates the effect of pulmonary and nonpulmonary immune-related adverse events (irAEs) on the efficacy of durvalumab treatment in patients with stage III NSCLC. Methods: We retrospectively assessed 158 patients who received durvalumab after CRT at nine Japanese institutions between July 2018 and March 2020. Survival outcomes were compared between patients who developed pneumonitis with those who developed irAEs other than pneumonitis. Patients who survived for less than 3 months were excluded to reduce immortal time bias. Results: Among 158 evaluated patients, 76 (48%) experienced grade less than or equal to one irAEs, whereas 82 (52%) experienced grade greater than or equal to two irAEs. Among the patients with grade greater than or equal to two irAEs, those with grade greater than or equal to two pneumonitis (n = 55) were compared with those with grade greater than or equal to two irAEs other than pneumonitis (n = 27). Patients with grade greater than or equal to two pneumonitis exhibited a significantly worse overall survival than those with grade greater than or equal to two irAEs that excluded pneumonitis. Multivariate analysis revealed that grade greater than or equal to two pneumonitis (hazard ratio = 3.71; 95% confidence interval, 1.85–7.45; p < 0.001) and squamous histology (hazard ratio = 2.64; 95% confidence interval, 1.29–5.42; p = 0.008) were independently associated with worse overall survival. Conclusions: After minimizing immortal time bias, pneumonitis grade two or greater and squamous histology were poor prognostic factors in patients who received consolidation durvalumab after 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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