Clinical outcomes in stage III non-small cell lung cancer patients treated with durvalumab after sequential or concurrent platinum-based chemoradiotherapy – single institute experience
, , , , y | 19 nov 2021
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Article Category: Research Article
Publicado en línea: 19 nov 2021
Páginas: 482 - 490
Recibido: 19 ago 2021
Aceptado: 07 oct 2021
DOI: https://doi.org/10.2478/raon-2021-0044
© 2021 Martina Vrankar, Karmen Stanic, Stasa Jelercic, Eva Ciric, Ana Lina Vodusek, Jasna But-Hadzic, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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Univariate and multivariate analysis of predictors for progression free survival
| Variable | Univariate analysis | Multivariate analysis | |||
|---|---|---|---|---|---|
| HR (95% CI) | p | HR (95 % CI) | p | ||
| Age | < 63 years | 0.67 (0.35–1.29) | 0.231 | ||
| ≥ 63 years | |||||
| Gender | Male | 0.62 (0.32–1.20) | 0.156 | ||
| Female | |||||
| ECOG PS | 0 | 0.66 (0.34–1.28) | 0.226 | ||
| 1–2 | |||||
| Stage | IIIA | 0.89 (0.54–1.48) | 0.663 | ||
| IIIB | |||||
| IIIC | |||||
| Histology | Adenocarcinoma | 0.84 (0.41–1.70) | 0.635 | ||
| Squamous Cell | |||||
| Smoking status | Never | 0.59 (0.33–1.07) | 0.084 | 1.72 (0.26–11.00) | 0.567 |
| Ex-smokers | |||||
| Smoking at diagnosis | |||||
| Mutational status | No | 0.99 (0.87–1.12) | 0.881 | ||
| KRAS | |||||
| PD-L1 | < 1% | 1.03 (0.67–1.59) | 0.882 | ||
| 1%–49% | |||||
| > 50% | |||||
| Time to durvalumab | < 57 days | 0.63 (0.32–1.24) | 0.186 | ||
| ≥ 57 days | |||||
| RT dose | < 60 Gy | 1.10 (0.43–2.84) | 0.838 | ||
| ≥ 60 Gy | |||||
| No of ChT | Up to 3 | 2.06 (0.94–4.51) | 0.069 | 0.83 (0.23–2.99) | 0.783 |
| 4–5 | |||||
| ChT | Sequential | 1.51 (0.79–2.85) | 0.209 | ||
| Concurrent | |||||
| Response after IT | CR | 0.066 (0.008–0.518) | 0.010 | 0.067 (0.008–0.535) | |
| PR/SD | |||||
| Durvalumab treatment time | < 10.8 months | 3.16 (1.62–6.17) | 0.001 | 1.18 (0.227–6.17 | 0.841 |
| ≥ 10.8 months | |||||
Chemoradiotherapy treatment characteristics
| N = 85 (%) | ||
|---|---|---|
| N of ChT | 1 | 3 (3.5%) |
| 2 | 13 (15.3%) | |
| 3 | 41 (48.2%) | |
| 4 | 27 (31.8%) | |
| 5 | 1 (1.2%) | |
| ChT | Gem/cis | 79 (92.9%) |
| Etop/cis | 52 (61.2%) | |
| Pem/cis | 3 (3.5%) | |
| ChT | Induction | 82 (96.5%) |
| Sequential only | 31 (36.5%) | |
| Concurrent | 54 (63.5%) | |
| Concurrent only | 3 (3.5%) | |
| RT dose (Gy) | Median (range) | 60 (5 –66) |
| V20 (Gy) | Median (range) | 27.2 (7.0–35.6) |
| MLD (Gy) | Median (range) | 15.7 (4.0–20.2) |
| PTV (cm3) | Median (range) | 416.6 (172.3–1282.6) |
| Evaluation after ChT-RT | CR | 10 (11.8%) |
| PR | 70 (82.3%) | |
| SD | 5 (5.9 %) | |
| Time between RT-IT (days) | Median (range) | 57 (12–99) |
Durvalumab treatment characteristics and influence on overall survival
| Treatment characteristics | N (%) | P | |
|---|---|---|---|
| Time between RT-IT | Median (days) | 57 (12–99) | 0.689 |
| < 57 | |||
| ≥ 57 | |||
| Treatment time of IT |
Median (months) | 10.8 (0.5–12.0) | |
| < 10.8 | |||
| ≥ 10.8 | |||
| Treatment with IT | Completed | 41 (48.2%) | 0.095 |
| Early stopped due to AE | 25 (29.4%) | ||
| Progression | 16 (18.8%) | ||
| Other | 3 (3.6%) | ||
| Response after IT** | CR | 29 (34.1%) | 0.213 |
| PR | 11 (12.9%) | ||
| SD | 15 (17.6%) | ||
| PD | 10 (11.8%) | ||
| Progression*** | Loco-regional | 21 (24.7%) | 0.217 |
| Metastatic | 10 (11.7%) | ||
| Metastatic and local | 5 (5.9%) | ||
| Metastatic spread | CNS | 5 (5.9%) | 0.101 |
| Other | 10 (11.7 %) | ||
Pattern of progression
| Progression (N of patients) | Loco-regional only | Metastatic | p | |
|---|---|---|---|---|
| Gender | Male | 12 | 10 | 0.563 |
| Female | 9 | 5 | ||
| Stage | IIIA | 7 | 3 | 0.663 |
| IIIB | 11 | 9 | ||
| IIIC | 3 | 3 | ||
| Histology | Adenocarcinoma | 2 | 9 | |
| Squamous cell | 19 | 5 | ||
| Other | 0 | 1 | ||
| Mutation | KRAS | 0 | 7 | |
| No mutation | 21 | 8 | ||
| PD-L1 | < 1% | 3 | 4 | |
| 1%–49 % | 8 | 6 | 0.435 | |
| 50 % | 10 | 4 | ||
Baseline characteristics of patients treated with durvalumab
| N = 85 | ||
|---|---|---|
| Gender | Female | 25 (29.4 %) |
| Male | 60 (70.6 %) | |
| Age | Median (range) | |
| < 63 | 63 (36 – 73) | |
| ≥ 63 | ||
| ECOG PS | 0 | 37 (43.5 %) |
| 1 | 46 (54.1 %) | |
| 2 | 2 (2.4 %) | |
| Smoking history | Never | 2 (2.4 %) |
| Ex-smokers | 35 (41.6 %) | |
| Smoking at diagnosis | 47 (56.0 %) | |
| Histology | Adenocarcinoma | 31 (36.5 %) |
| Squamous Cell | 50 (58.8 %) | |
| Other | 4 (4.7 %) | |
| AJCC 8th Edition Stage | IIIA | 26 (30.6%) |
| IIIB | 48 (56.5 %) | |
| IIIC | 11 (12.9 %) | |
| PD-L1 Expression | < 1% | 13 (15.3 %) |
| 1%-49% | 33 (38.8 %) | |
| > 50% | 32 (37.7 %) | |
| Unavailable | 7 (8.2 %) | |
| Mutational status | No mutations | 65 (76.5 %) |
| KRAS | 16 (18.8 %) | |
| Unavailable | 4 (4.7 %) |