Effect of durvalumab in patients with unresectable stage 3 non–small cell lung cancer post-chemoradiotherapy.

Authors

Aswani Thurlapati

Aswani Thurlapati

Department of Internal Medicine, LSU Health Science Center, Shreveport, LA

Aswani Thurlapati , Lovekirat Singh Dhaliwal , Sumasri Chennapragada , Pranavteja Gutta , Diana Song , Deepika Ralla , Jill Comeau , Runhua Shi , Kavitha Beedupalli

Organizations

Department of Internal Medicine, LSU Health Science Center, Shreveport, LA, LSU Health Shreveport, Shreveport, LA, Feist-Weiller Cancer Center, LSU-Health Shreveport, ULM School of Pharmacy, Shreveport, LA, LSU Health Sciences Center, Shreveport, LA, Baylor College of Medicine, Houston, TX

Research Funding

No funding received

Background: The PACIFIC study (PS) concluded that the use of durvalumab from 1 to 42 days after concurrent chemoradiotherapy (CXRT) in stage 3 unresectable non-small cell lung cancer (NSCLC) increased the median overall survival (mOS) from 29 to 48 months. It also showed a benefit in tumors with PD-L1 <25%. However, a post-hoc analysis of the PS showed no survival benefit with durvalumab in patients with PD-L1 <1% but was not statistically powered. Currently in the US, durvalumab is approved irrespective of PDL-1 percentage, whereas in Europe it is not approved for tumors with PDL-1 <1%. Also, there was no survival benefit in starting durvalumab within and after 2 weeks of CXRT. Our objectives in this study are to analyze the impact of PDL-1 expression and the date of initiation of durvalumab post CXRT on mOS. Methods: We conducted a retrospective observational study of stage 3 unresectable NSCLC patients who received durvalumab post CXRT at LSU Health Shreveport from 2018 to 2021. A survival analysis was done including the following variables: age, race, sex, tumor histology, tumor PD-L1 percentage, and date of initiation of durvalumab post CXRT. P-value <0.05 was considered statistically significant. Results: We identified 83 patients who received durvalumab after CXRT for treatment of stage 3 unresectable NSCLC. Baseline characteristics are provided in table 1. Among all the tumors, 25% had a PDL-1 <1%. 33% of the study population received durvalumab less than 30 days after CXRT and 67% received it after 30 days. The mOS was not impacted by race, sex, or tumor hisotology. Compared to higher PDL-1 percentage, patients with PD-L1 <1% had a statistically significant lower survival probability. At 14 months, 87% of patients with a PD-L1 <1% were alive compared to 100% in those with a PD-L1 1-50% or a PD-L1 >50%. Less than 35% of patients with PD-L1 <1% survived beyond 30 months compared to 45% for PD-L1 1-50% and 100% for PD-L1 >50% (p-value 0.02). Patients who received durvalumab 30-60 days after concurrent CXRT had a lower OS at 30 months compared to those who started before 30 days (44% versus 90%). However, statistical significance was not reached (p-value 0.45). Conclusions: This study demonstrates that patients with a PD-L1 tumor expression of <1% had a statistically significant lower survival probability compared to those with a PD-L1 expression of 1-50% and > 50% in this patient population. Time from CXRT to the start of durvalumab was not shown to affect survival outcomes.

Baseline characteristics of the study group.

Characteristics

Age
63 (42 to 88)
Sex

Male
56 (67.5%)
Female
27 (32.5%)
Race

White
37 (45.1%)
African American
45 (54.9%)
Tumor Histology

SCC
44 (53%)
Adenocarcinoma
32 (38.6%)
Other
7 (8.4%)
PDL-1 expression

PDL-1 <1%
21 (25.3%)
PDL-1 1-50%
20 (24.1%)
PDL-1 >50%
20 (24.1%)
Unknown
22 (26.5%)
Start of Durvalumab post CXRT (in days)

<30
28 (33.7%)
30-60
36 (43.4%)
>60
19 (22.9%)

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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

Local-Regional Non–Small Cell Lung Cancer

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 8550)

DOI

10.1200/JCO.2022.40.16_suppl.8550

Abstract #

8550

Poster Bd #

177

Abstract Disclosures