Impact of durvalumab re-administration after moderate symptomatic pneumonitis in locally advanced non-small cell lung cancer

IF 4.5 2区医学 Q1 ONCOLOGY

Lung Cancer Pub Date : 2025-05-06 DOI:10.1016/j.lungcan.2025.108578

Yosuke Kakiuchi , Koichi Saruwatari , Takaaki Tokito , Toyohisa Iriki , Jun Iwakawa , Yoshihiko Sakata , Naoki Shingu , Sho Saeki , Megumi Inaba , Akira Takaki , Shunsuke Misono , Takayuki Suetsugu , Kenta Murotani , Koichi Azuma , Keiko Mizuno , Takuro Sakagami

{"title":"Impact of durvalumab re-administration after moderate symptomatic pneumonitis in locally advanced non-small cell lung cancer","authors":"Yosuke Kakiuchi , Koichi Saruwatari , Takaaki Tokito , Toyohisa Iriki , Jun Iwakawa , Yoshihiko Sakata , Naoki Shingu , Sho Saeki , Megumi Inaba , Akira Takaki , Shunsuke Misono , Takayuki Suetsugu , Kenta Murotani , Koichi Azuma , Keiko Mizuno , Takuro Sakagami","doi":"10.1016/j.lungcan.2025.108578","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The standard of care for unresectable locally advanced non-small cell lung cancer (LA-NSCLC) includes post-chemoradiotherapy durvalumab consolidation therapy. However, moderate symptomatic pneumonitis (Grade 2) constitutes a significant adverse event that frequently leads to treatment interruption and warrants careful consideration of re-administration. We evaluated the efficacy and safety of durvalumab re-administration after recovery from grade 2 pneumonitis.</div></div><div><h3>Methods</h3><div>This retrospective study included 208 patients with LA-NSCLC who received post-chemoradiotherapy durvalumab consolidation therapy at seven institutions between July 2018 and March 2022. Among them, 62 developed Grade 2 pneumonitis that led to treatment interruption and were stratified into the durvalumab re-administration (n = 33) and durvalumab non-re-administration (n = 29) groups. Survival outcomes were analyzed using the Cox proportional hazards model.</div></div><div><h3>Results</h3><div>Participants in the durvalumab re-administration group had significantly longer progression-free survival (PFS; 32.0 months [95 % confidence interval (CI): 11.7–Not Available (NA)] vs. 5.3 months [95 % CI: 3.5–17.4], <em>P</em> = 0.003) and overall survival (OS; not reached [95 % CI: 29.0–NA] vs. 27.1 months [95 % CI: 12.1–NA], <em>P</em> = 0.012) than in the durvalumab non-re-administration group. Pneumonitis recurred in 30.3 % of the re-administration group, albeit without Grade ≥ 3 events. Multivariate analysis identified durvalumab re-administration as an independent predictor of improved survival, with hazard ratios of 0.31 (95 % CI: 0.15–0.65, <em>P</em> = 0.002) for PFS and 0.33 (95 % CI: 0.13–0.82, <em>P</em> = 0.017) for OS.</div></div><div><h3>Conclusion</h3><div>Durvalumab re-administration after grade 2 pneumonitis was associated with prolonged survival and a low recurrence rate of mild pneumonitis, which suggests that re-administration is a feasible, effective strategy with adequate monitoring.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"204 ","pages":"Article 108578"},"PeriodicalIF":4.5000,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lung Cancer","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0169500225004702","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The standard of care for unresectable locally advanced non-small cell lung cancer (LA-NSCLC) includes post-chemoradiotherapy durvalumab consolidation therapy. However, moderate symptomatic pneumonitis (Grade 2) constitutes a significant adverse event that frequently leads to treatment interruption and warrants careful consideration of re-administration. We evaluated the efficacy and safety of durvalumab re-administration after recovery from grade 2 pneumonitis.

Methods

This retrospective study included 208 patients with LA-NSCLC who received post-chemoradiotherapy durvalumab consolidation therapy at seven institutions between July 2018 and March 2022. Among them, 62 developed Grade 2 pneumonitis that led to treatment interruption and were stratified into the durvalumab re-administration (n = 33) and durvalumab non-re-administration (n = 29) groups. Survival outcomes were analyzed using the Cox proportional hazards model.

Results

Participants in the durvalumab re-administration group had significantly longer progression-free survival (PFS; 32.0 months [95 % confidence interval (CI): 11.7–Not Available (NA)] vs. 5.3 months [95 % CI: 3.5–17.4], P = 0.003) and overall survival (OS; not reached [95 % CI: 29.0–NA] vs. 27.1 months [95 % CI: 12.1–NA], P = 0.012) than in the durvalumab non-re-administration group. Pneumonitis recurred in 30.3 % of the re-administration group, albeit without Grade ≥ 3 events. Multivariate analysis identified durvalumab re-administration as an independent predictor of improved survival, with hazard ratios of 0.31 (95 % CI: 0.15–0.65, P = 0.002) for PFS and 0.33 (95 % CI: 0.13–0.82, P = 0.017) for OS.

Conclusion

Durvalumab re-administration after grade 2 pneumonitis was associated with prolonged survival and a low recurrence rate of mild pneumonitis, which suggests that re-administration is a feasible, effective strategy with adequate monitoring.

查看原文本刊更多论文

局部晚期非小细胞肺癌中度症状性肺炎后重新给药杜伐单抗的影响

不可切除的局部晚期非小细胞肺癌（LA-NSCLC）的标准治疗包括放化疗后的durvalumab巩固治疗。然而，中度症状性肺炎（2级）构成严重不良事件，经常导致治疗中断，需要仔细考虑重新给药。我们评估了杜伐单抗在2级肺炎康复后重新给药的有效性和安全性。方法本回顾性研究包括2018年7月至2022年3月在7家机构接受化疗后杜伐单抗巩固治疗的208例LA-NSCLC患者。其中62例发展为2级肺炎，导致治疗中断，分为杜伐单抗再给药组（n = 33）和杜伐单抗非再给药组（n = 29）。生存结局采用Cox比例风险模型进行分析。结果杜伐单抗再给药组患者的无进展生存期（PFS）显著延长；32.0个月[95%可信区间（CI）： 11.7-Not Available (NA)] vs. 5.3个月[95% CI: 3.5-17.4], P = 0.003]和总生存期(OS；未达到[95% CI: 29.0-NA] vs. 27.1个月[95% CI: 12.1-NA], P = 0.012]的durvalumab非再给药组。30.3%的再给药组肺炎复发，尽管没有≥3级事件。多因素分析表明，杜伐单抗再给药是改善生存的独立预测因子，PFS的风险比为0.31 (95% CI: 0.15-0.65, P = 0.002)， OS的风险比为0.33 （95% CI: 0.13-0.82, P = 0.017）。结论2级肺炎后再次给药durvalumab可延长患者的生存期，降低轻度肺炎的复发率，提示在充分监测的情况下再次给药是一种可行、有效的策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Lung Cancer 医学-呼吸系统

CiteScore

9.40

自引率

3.80%

发文量

407

审稿时长

25 days

期刊介绍： Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.