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Borghetti P, Volpi G, Facheris G, Cossali G, Mataj E, La Mattina S, Singh N, Imbrescia J, Bonù ML, Tomasini D, Vitali P, Greco D, Bezzi M, Melotti F, Benvenuti M, Borghesi A, Grisanti S, Buglione di Monale e Bastia M. Unresectable stage III non-small cell lung cancer: could durvalumab be safe and effective in real-life clinical scenarios? Results of a single-center experience. Front Oncol 2023; 13:1208204. [PMID: 37469420 PMCID: PMC10352832 DOI: 10.3389/fonc.2023.1208204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/09/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction The standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC) is chemoradiotherapy (CRT) followed by consolidation durvalumab as shown in the PACIFIC trial. The purpose of this study is to evaluate clinical outcomes and toxicities regarding the use of durvalumab in a real clinical scenario. Methods A single-center retrospective study was conducted on patients with a diagnosis of unresectable stage III NSCLC who underwent radical CRT followed or not by durvalumab. Tumor response after CRT, pattern of relapse, overall survival (OS) and progression-free survival (PFS), and toxicity profile were investigated. Results Eighty-five patients met the inclusion criteria. The median age was 67 years (range 45-82 years). Fifty-two patients (61.2%) started sequential therapy with durvalumab. The main reason for excluding patients from the durvalumab treatment was the expression of PD-L1 < 1%. Only two patients presented a grade 4 or 5 pneumonitis. A median follow-up (FU) of 20 months has been reached. Forty-five patients (52.9%) had disease progression, and 21 (24.7%) had a distant progression. The addition of maintenance immunotherapy confirmed a clinical benefit in terms of OS and PFS. Two-year OS and PFS were respectively 69.4% and 54.4% in the durvalumab group and 47.9% and 24.2% in the no-durvalumab group (p = 0.015, p = 0.007). Conclusion In this real-world study, patients treated with CRT plus durvalumab showed clinical outcomes and toxicities similar to the PACIFIC results. Maintenance immunotherapy after CRT has been shown to be safe and has increased the survival of patients in clinical practice.
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Affiliation(s)
- Paolo Borghetti
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Giulia Volpi
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Giorgio Facheris
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Gianluca Cossali
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Eneida Mataj
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Salvatore La Mattina
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Navdeep Singh
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Jessica Imbrescia
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Marco Lorenzo Bonù
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Davide Tomasini
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Paola Vitali
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Diana Greco
- Radiation Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Michela Bezzi
- Division of Pneumology, University Hospital Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Flavia Melotti
- Institute of Pathology, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Mauro Benvenuti
- Thoracic Surgery, Department of Cardio-Thoracic Surgery, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy
| | - Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Medical Oncology Department, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili and University of Brescia, Brescia, Italy
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