Pre-existing interstitial lung abnormalities are independent risk factors for interstitial lung disease during durvalumab treatment after chemoradiotherapy in patients with locally advanced non–small lung cancer.

Authors

null

Wakako Daido

Department of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, Japan

Wakako Daido , Takeshi Masuda , Nobuki Imano , Naoko Matsumoto , Hiroyasu Shoda , Kosuke Hamai , Yasuo Iwamoto , Yusuke Takayama , Shohei Mishima , Ken Masuda , Shigeo Kawase , Yoshikazu Awaya , Yoshifumi Nishimura , Naoki Shiota , Nobuhisa Ishikawa , Masahiro Yamasaki , Soichi Kitaguchi , Kazunori Fujitaka , Yasushi Nagata , Noboru Hattori

Organizations

Department of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, Japan, Department of Radiation Oncology, Hiroshima University Hospital, Hiroshima, Japan, Department of Respiratory Internal Medicine, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan, Department of Respiratory Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan, Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan, Department of Medical Oncology, Hiroshima City Hospital Organization Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan, Department of Respiratory Medicine, Kure Kyosai Hospital, Kure, Japan, Department of Respiratory Medicine, Miyoshi Central Hospital, Miyoshi, Japan, Department of Respiratory Medicine, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima, Japan, Department of Respiratory Disease, Chugoku Rousai General Hospital, Kure, Japan, Department of Respiratory Internal Medicine, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan

Research Funding

No funding received

Background: The standard treatment for locally advanced non-small cell lung cancer (NSCLC) is chemoradiotherapy (CRT) followed by treatment of durvalumab, one of immune checkpoint inhibitors (ICI). Interstitial lung disease (ILD) is a clinically life-threatening toxicity of CRT or durvalumab. The patient-characteristics or dose-volume histogram parameters of radiotherapy have been reported to be the risk factors for radiation-induced pneumonitis. However, the risk factors for ILD during durvalumab therapy has not been established. Interstitial lung abnormalities (ILA) are generated by aging or smoking, and manifest as minor interstitial shadow on lung computed tomography (CT). We previously reported that ILA were risk factors for ICI-induced ILD in patients with advanced NSCLC, as well as non-lung cancer. Therefore, we investigated whether ILA could be risk factors for ILD during the durvalumab therapy. Methods: We retrospectively enrolled NSCLC patients who received durvalumab after CRT at 10 institutions from July 2018 to June 2021. Patient-information, patient-characteristics, dose-volume histogram parameters, chest CT findings, and laboratory data, were obtained. CT findings were examined using CT obtained after CRT and prior to durvalumab therapy. Results: A total of 153 patients were enrolled, and the prevalence of ILA was 37.8% (56 patients) before durvalumab treatment. Among the enrolled patients, 94 (63.5%) developed ILD during durvalumab therapy. The proportion of patients with grade 1, grade 2, or grade 3 ILD was observed to be 29.7% (44 patients), 25.7% (38 patients), and 8% (12 patients), respectively. Univariate logistic regression analysis revealed that higher age, higher dose volume histogram parameters (V5, V20, mean lung dose), and the presence of ILA were significant risk factors for grade 2 or more ILD. Multivariate logistic regression analysis showed that ILA, especially ground grass attenuation in ILA, was an independent risk factor for grade 2 or more ILD (odds ratio: 7.02, 95% CI: 2.95-16.69, p < 0.0001). Conclusions: Pre-existing ILA are risk factors for ILD during durvalumab treatment after CRT. This observation is consistent with previously reported findings in patients with advanced lung cancer and non-lung cancer. Therefore, we should pay more attention to the development of grade 2 or more ILD during durvalumab treatment in patients with ILA.

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lung Cancer—Non-Small Cell Local-Regional/Small Cell/Other Thoracic Cancers

Track

Lung Cancer

Sub Track

Biologic Correlates

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 8528)

DOI

10.1200/JCO.2022.40.16_suppl.8528

Abstract #

8528

Poster Bd #

155

Abstract Disclosures