Factors associated with failure to start consolidation durvalumab after definitive chemoradiation for locally advanced NSCLC.

Autor:	Langberg CW; Faculty of Medicine, University of Oslo, Oslo, Norway., Horndalsveen H; Department of Oncology, Oslo University Hospital, Oslo, Norway.; Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway., Helland Å; Department of Oncology, Oslo University Hospital, Oslo, Norway.; Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.; Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway., Haakensen VD; Department of Oncology, Oslo University Hospital, Oslo, Norway.; Department of Cancer Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway.
Jazyk:	angličtina
Zdroj:	Frontiers in oncology [Front Oncol] 2023 Jul 05; Vol. 13, pp. 1217424. Date of Electronic Publication: 2023 Jul 05 (Print Publication: 2023).
DOI:	10.3389/fonc.2023.1217424
Abstrakt:	Introduction: The introduction of consolidation immunotherapy after chemoradiotherapy has improved outcome for patients with locally advanced non-small cell lung cancer. However, not all patients receive this treatment. This study identifies factors associated with failure to start durvalumab as consolidation therapy with the aim of optimizing treatment, supportive care and prehabilitation to ensure that more patients complete the planned treatment. Materials and Methods: Patients from two clinical trials and a named patient use program, were included in this study. All patients received platinum-doublet chemotherapy concomitant with radiotherapy to a total dose of 60-66 gray. Patient characteristics, cancer treatment, toxicity, performance status and laboratory data before and after chemoradiotherapy were recorded and patients who never started durvalumab were compared with those who did. Results: A total of 101 patients were included, of which 83 started treatments with durvalumab after chemoradiotherapy. The 18 patients who did not start durvalumab had significantly higher lactate dehydrogenase at baseline and a worse performance status, cumulative toxicity and higher c-reactive protein after completed chemoradiotherapy. Data also suggest that pre-treatment diabetes and reduced hemoglobin and/or diffusion capacity of the lungs for carbon monoxide contribute to the risk of treatment abruption. Conclusion: Treatment plan disruption rate was 18%. Systemic inflammation and performance status were associated with failure to receive durvalumab after chemoradiation. Further studies are needed to confirm findings and prospective trials should investigate whether prehabilitation and supportive treatment could help more patients finishing the planned treatment. Clinical Trial Registration: clinicaltrials.gov, identifier NCT03798535; NCT04392505. Competing Interests: This study has not received funding, but is based on data from trials funded completely or partially by Astra Zeneca. No funder has been involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication. ÅH has received study funding and honoraria from Astra Zeneca, but all payments have gone to the hospital and not to personal accounts. HH and VDH have received honoraria from Astra Zeneca for lectures and/or advisory boards, payments to personal accounts. The authors declare no other competing interests. (Copyright © 2023 Langberg, Horndalsveen, Helland and Haakensen.)
Databáze:	MEDLINE
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