Clinical outcomes in stage III non-small cell lung cancer patients treated with durvalumab after sequential or concurrent platinum-based chemoradiotherapy – single institute experience
Background. Chemoradiotherapy followed by 12-month durvalumab is the new standard treatment for unresectable stage III non small cell lung cancer. Survival data for sequential chemoradiotherapy before durvalumab treatment in every day routine clinical practice is scarce, as well as the usage of gemcitabine in this treatment regimen.
Patients and methods. We retrospectively analysed unresectable stage III NSCLC patients who were treated with durvalumab after radical concurrent or sequential chemoradiotherapy and completed treatment until December 2020. We assessed progression free survival, overall survival and toxicity regarding baseline characteristic of patients.
Results. Eighty-five patients with median age of 63 years of which 70.6 % were male, 56.5 % in stage IIIB and 58.8 % with squamous cell carcinoma, were included in the analysis. Thirty-one patients received sequential ChT only, 51 patients received induction and concurrent ChT and 3 patients received concurrent ChT only. Seventy nine patients (92.5 %) received gemcitabine and cisplatin as induction chemotherapy and switched to etoposide and cisplatin during concurrent treatment with RT. Patients started durvalumab after a median of 57 days (range 12 – 99 days) from the end of the RT and were treated with the median of 10.8 (range 0.5 – 12 months) months. Forty-one patients (48.3 %) completed treatment with planned 12-month therapy, 25 patients (29.4 %) completed treatment early due to the toxicity and 16 patients (18.8 %) due to the disease progression. Median PFS was 22.0 months, 12- and estimated 24-month PFS were 71 % (95% CI: 61.2-80.8 %) and 45.8 % (95% CI: 32.7-58.9 %). Median OS has not been reached. Twelve- and estimated 24-month OS were 86.7 % (95% CI: 79.5-93.9 %) and 68.6 % (95% CI: 57.2-79.9 %).
Conclusions. Our survival data are comparable with the Pacific trial as well as with recently published real-world reports. PFS and OS did not differ in patients with sequential chemotherapy only or concurrent chemotherapy. Additionally, the regimen with gemcitabine and platinum-based chemotherapy as induction treatment was efficient and well tolerated.
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