Objectives

The incidence of real-world pneumonitis and durvalumab rechallenge during chemoradiotherapy and durvalumab consolidation for non-small cell lung cancer is unknown.

Materials and methods

We retrospectively evaluated the medical records of 302 consecutive patients diagnosed with non-small cell lung cancer who started chemoradiotherapy between May 2018 and May 2019.

Results

Median age was 70 (range: 40–87) years. Volume of lung parenchyma that received 20 Gy (V20) exceeded 35% in 2% and mean lung dose exceeded 20 Gy in 1% of patients. Durvalumab consolidation was delivered to 225 patients (75%). Overall, 83% (n = 251), 34% (n = 103), 7% (n = 21), and 1% (n = 4) of the patients developed any grade of pneumonitis, symptomatic pneumonitis, ≥grade 3 pneumonitis, and fatal (grade 5) pneumonitis, respectively. Corticosteroids were administered to 25% of the patients to treat pneumonitis. Multivariate analysis identified the predictive factors for the development of symptomatic pneumonitis: V20 Gy or more ≥ 25% (odds ratio [OR]: 2.37, P = 0.008) and mean lung dose (MLD) ≥ 10 Gy (OR: 1.93, P < 0.0047). Of the 52 patients who received corticosteroids for pneumonitis after durvalumab initiation, 21 were rechallenged with durvalumab. Overall, 81% of patients met the PACIFIC study’s rechallenge criteria and did not experience a severe pneumonitis relapse.

Conclusion

High V20 and MLD were independent risk factors of symptomatic pneumonitis. More than 80% of the patients who were rechallenged with durvalumab after pneumonitis met the PACIFIC study’s rechallenge criteria. Consequently, severe relapse did not occur. Cooperation between radiation and medical oncologists is important for safe chemoradiotherapy and the safe completion of durvalumab consolidation therapy.

中文翻译：

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在 durvalumab 批准后接受放化疗的非小细胞肺癌患者肺炎及其对 durvalumab 巩固治疗的影响的真实世界调查 (HOPE-005/CRIMSON)

目标

非小细胞肺癌的放化疗和 durvalumab 巩固治疗期间真实世界肺炎和 durvalumab 再次挑战的发生率尚不清楚。

材料和方法

我们回顾性评估了 2018 年 5 月至 2019 年 5 月期间开始放化疗的 302 名连续诊断为非小细胞肺癌患者的病历。

结果

中位年龄为 70（范围：40-87）岁。接受 20 Gy (V20) 的肺实质体积在 2% 的患者中超过 35%，在 1% 的患者中平均肺剂量超过 20 Gy。225 名患者 (75%) 接受了 Durvalumab 巩固治疗。总体而言，83% (n = 251)、34% (n = 103)、7% (n = 21) 和 1% (n = 4) 的患者发展为任何级别的肺炎、症状性肺炎、≥3 级肺炎，和致命的（5级）肺炎，分别。25% 的患者使用皮质类固醇治疗肺炎。多变量分析确定了症状性肺炎发展的预测因素：V20 Gy 或更多 ≥ 25%（优势比 [OR]：2.37，P  = 0.008）和平均肺剂量 (MLD) ≥ 10 Gy（OR：1.93，P < 0.0047)。在 durvalumab 开始后接受皮质类固醇治疗肺炎的 52 名患者中，21 名再次接受 durvalumab 治疗。总体而言，81% 的患者符合 PACIFIC 研究的再挑战标准，并且没有经历严重的肺炎复发。

结论

高 V20 和 MLD 是症状性肺炎的独立危险因素。在肺炎后再次接受 durvalumab 治疗的患者中，超过 80% 符合 PACIFIC 研究的再治疗标准。因此，没有发生严重的复发。放射科医生和内科肿瘤科医生之间的合作对于安全放化疗和安全完成 durvalumab 巩固治疗非常重要。