방사선종양학

  • [Lung Cancer.] Real world data of durvalumab consolidation after chemoradiotherapy in stage III non-small-cell lung cancer 폐암에서 항암 방사선 치료 후 Durvalumab 유지 요법

    성균관의대 / 정현애, 노재명, 박근칠*

  • 출처
    Lung Cancer.
  • 등재일
    2020 Aug
  • 저널이슈번호
    146:23-29. doi: 10.1016/j.lungcan.2020.05.035. Epub 2020 May 31.
  • 내용

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    Abstract
    Objectives: The PACIFIC study demonstrated the benefits of durvalumab consolidation on progression-free survival (PFS) and overall survival (OS) among patients with unresectable locally advanced non-small-cell lung cancer (LA-NSCLC). However, in real-world practice, patients with unresectable LA-NSCLC are heterogeneous with diverse tumor burdens and clinical factors; thus, it is important to examine the effectiveness and side effects of durvalumab when used in real clinical practice.

    Materials and methods: We investigated the efficacy of durvalumab consolidation and the incidence of radiation pneumonitis in patients who received concurrent chemo-radiotherapy (CCRT) for unresectable LA-NSCLC in a single institute.

    Results: Overall, 55.3 % of patients did not meet the criteria of the PACIFIC study; however, they still received consolidation durvalumab in real-world practice. Durvalumab consolidation was associated with favorable PFS in the total population as well as in the subgroup of patients who did not meet the criteria of the PACIFIC study. However, radiation pneumonitis occurred more frequently in the durvalumab group, especially within 3-6 months after CCRT. The incidence of grade 3 radiation pneumonitis was 14.3 % in the durvalumab group versus 2.5 % in the observation group.

    Conclusions: Durvalumab consolidation was associated with favorable PFS in patients with LA-NSCLC in clinical practice. However, careful selection of candidates for durvalumab treatment and active surveillance and appropriate management for radiation pneumonitis are needed.

     

       

    Affiliations

    Hyun Ae Jung  1 , Jae Myoung Noh  2 , Jong-Mu Sun  1 , Se-Hoon Lee  1 , Jin Seok Ahn  1 , Myung-Ju Ahn  1 , Hongryull Pyo  2 , Yong Chan Ahn  2 , Keunchil Park  3
    1 Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
    2 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
    3 Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: kpark@skku.edu.

  • 키워드
    Concurrent chemo-radiotherapy; Consolidation; Durvalumab; Non-small-cell lung cancer.
  • 편집위원

    PACIFIC trial 이후 국내에서 durvalumab 사용에 대한 치료성적과 부작용을 분석한 단일기관 후향적 연구

    2020-10-05 17:34:15

  • 편집위원2

    Stage III NSCLC에 대한 PACIFIC study는 방사선치료와 관련된 여러인자들이(total dose 54-66 Gy, Dmean of lung <20 Gy, V20Gy<35%) 선정기준에 포함되고 이를 만족할 때 Gr 3 or 4 RP가 4.4% in durvalumab vs 3.8% in placebo인데 반해서, 55%가 PACIFIC study를 만족못하는 현 연구에서는 Gr 3 RP가 14.3% in durvalumab vs 2.5% in observation (PFS 향상은 통계적으로 유의하지 않음)임을 고려하면 임상에서 해당 환자 치료시엔 치료효과와 독성을 고려해서 선량과 constraints를 적용해야하겠습니다.

    2020-10-05 17:37:07

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