ANN ARBOR, MI – Median overall survival doubled for veterans with stage III non-small cell lung cancer who received chemoradiotherapy plus durvalumab, as compared to those receiving chemoradiotherapy alone, according to a new study.
A study associated with the 2021 American Society of Clinical Oncology (ASCO) annual meeting pointed out that the current standard of care for patients with unresectable stage III non-small-cell lung cancer (NSCLC) is concurrent chemoradiotherapy followed by durvalumab maintenance, based on outcomes from the PACIFIC trial.1
“However, PACIFIC did not include veterans, a unique population with significant co-morbidities; thus, the impact of durvalumab on survival of veterans with stage III NSCLC is unknown,” wrote researchers from the University of Michigan and the VA Ann Arbor Healthcare System.
Using the VA’s Corporate Data Warehouse, the study team selected patients with stage III NSCLC who received chemoradiotherapy and at least one dose of durvalumab to gather that information. 2
Of the 1,106 veterans meeting inclusion criteria, median age was 69, more than 95% were male, and the median Charlson Comorbidity Index was 1. A majority of patients, 86.4%, reported current or former tobacco use. About half, 48.1%, had adenocarcinoma histology, 48.4% had squamous cell, and 0.5% large cell, 0.3% had neuroendocrine and 0.1% had sarcomatoid.
In terms of staging, 60% had AJCC 8th edition stage IIIA disease, 34.5% stage IIIB, and 3.3% stage IIIC. Median progression-free survival was 19.9 months (95% CI: 16.9 – 23.6), and median overall survival was 34.9 months (95% CI: 29.7 – not reached).
Analyses indicated that adenocarcinoma histology (HR 1.14, p = 0.03) predicted progression, while older age (HR 1.03, p< 0.0001) and stage IIIB/IIIC disease (HR 1.05, p = 0.008) predicted inferior overall survival.
During the study period, 18.4% of patients completed all planned cycles of adjuvant durvalumab. The median number of durvalumab infusions received was 6 (range: 1 – 38). Researchers noted that, among evaluable patients, 19.4% discontinued durvalumab for progression, 23.4% discontinued for suspected immune-related toxicity and 1.9% died during treatment.
“While several factors have led to the improvement of OS in patients with stage III NSCLC over time, we report a doubling of median OS in veterans with stage III NSCLC who received chemoradiotherapy plus durvalumab as compared to historical cohorts who received chemoradiotherapy alone,” the authors concluded. “Veterans in our study received a lower median number of durvalumab infusions as compared to patients in the PACIFIC trial (6 vs. 14), and a significant proportion discontinued durvalumab due to suspected immune-mediated toxicity (23.4%).”
Researchers advised that, if further analyses confirm their findings, “investigation of alternative dosing regimens and/or dosing intervals of durvalumab in order to balance safety and efficacy of durvalumab therapy in veterans is warranted.”
- Antonia SJ, Villegas A, Daniel D, Vicente D, Murakami S, et. Al. PACIFIC Investigators. Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC. N Engl J Med. 2018 Dec 13;379(24):2342-2350. doi: 10.1056/NEJMoa1809697. Epub 2018 Sep 25. PMID: 30280658.
- Sankar K, Bryant AK, Green M. Ramnath N. (June 4-8, 2021). Doubling of median overall survival in a nationwide cohort of veterans with stage III non-small cell lung cancer in the durvalumab era. ASCO 2021 annual meeting. Virtual. https://meetinglibrary.asco.org/record/198872/abstract
