Utilization and Factors Precluding Receipt of Checkpoint Inhibitor Consolidation for Stage III NSCLC in a Large US Academic Health System.

We sought to determine the proportion of patients with stage III non-small cell lung cancer (NSCLC) who initiate consolidation durvalumab or other immune checkpoint inhibitors (ICIs) after concurrent chemoradiotherapy (cCRT), as well as reasons for nonreceipt and prognostic implications. We retrospectively identified consecutive patients with unresectable stage III NSCLC treated with definitive cCRT between October 2017 and December 2021 within a large US academic health system. Patients either received consolidation ICIs (ICI group) or did not (no-ICI group). Baseline characteristics and overall survival (OS) of the groups were assessed. Factors predictive of ICI nonreceipt were evaluated using logistic regression. Of 333 patients who completed cCRT, 229 (69%) initiated consolidation ICIs; 104 (31%) did not. Reasons for ICI nonreceipt included progressive disease post-cCRT (N = 31, 9%), comorbidity or intercurrent illness (N = 25, 8%), cCRT toxicity (N = 23, 7%; 19/23 pneumonitis), and EGFR/ALK alteration (N = 14, 4%). The no-ICI group had worse performance status and a higher rate of baseline pulmonary comorbidity. Larger planning target volume was associated with post-cCRT progressive disease, and higher lung radiation dose with cCRT toxicity. Median OS was 16 months in the no-ICI group and 34.4 months in the ICI group. In the no-ICI group, OS was superior among those with EGFR/ALK alterations (median 44.5 months) and worst among those with progressive disease (median 5.9 months, P < 0.001). 31% of patients who completed cCRT for stage III NSCLC did not receive consolidation ICIs. Survival amongst these patients is poor, especially for those with progressive disease post-cCRT.

Informations de copyright

Copyright © 2023 Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Disclosure ATB - Employment: CVS Health. RBC - Consulting or Advisory Role: AstraZeneca Pharmaceuticals, Cantargia. Research Funding: Fstar, Cantargia. CA - Consulting or Advisory Role: AstraZeneca Pharmaceuticals, Merck & Co, Janssen Pharmaceuticals (J&J), Sanofi Genzyme, Pfizer Inc. MEM - Consulting or Advisory Role: Ikena. Research Funding: Eli Lilly, Merck & Co, AstraZeneca Pharmaceuticals. CJL - Consulting or Advisory Role: Amgen, AstraZeneca Pharmaceuticals, Takeda Pharmaceuticals, Genentech, Novocure, Regeneron Pharmaceuticals, Pfizer Inc., Sanofi Genzyme. Research Funding: Merck & Co, Janssen Pharmaceuticals (J&J), Incyte Corporation.