Safety monitoring of two and four-weekly adjuvant durvalumab for patients with stage III NSCLC: implications for the COVID-19 pandemic and beyond. (June 2021)

• Record Type: Journal Article
• Authors: Joshi, Kroopa; Muhith, Abdul; Obeid, Mariam; Milner-Watts, Charlotte; Yousaf, Nadia; Popat, Sanjay; Davidson, Michael; Bhosle, Jaishree; O'Brien, Mary; Minchom, Anna
• Is Part Of: Lung cancer. Volume 156(2021)
• Page Start: 147
• Page End: 150
• Publication Date: 2021-06
• Subjects: NSCLC -- Adjuvant durvalumab -- COVID-19 pandemic; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2021.04.021
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Similar toxicity to 4 and 2 weekly durvalumab in stage III NSCLC in real-world data. Four-weekly durvalumab minimises hospital visits during COVID-19 pandemic. Adapted monitoring of 4 weekly durvalumab does not compromise safety. Pre-existing autoimmune conditions are a risk factor for grade 3 or 4 toxicities. Abstract: Durvalumab is the first approved adjuvant immunotherapy agent for patients with stage III NSCLC treated with concurrent chemoradiotherapy and is associated with improved overall survival. In order to minimise the number of hospital visits for patients receiving durvalumab during the COVID-19 pandemic we implemented 4-weekly (20 mg/kg) durvalumab in place of 2-weekly infusions at The Royal Marsden Hospital. We assessed the potential impact of the safety of a 4-weekly schedule in patients receiving adjuvant durvalumab. We carried out a retrospective study of 40 patients treated with 2-weekly and 4-weekly infusions of durvalumab prior to and during the COVID-19 pandemic. Clinical documentation was analysed from 216 consultations across 40 patients receiving 2-weekly durvalumab and 66 consultations of 14 patients who switched from 2-weekly to 4-weekly durvalumab during the COVID-19 pandemic. In patients receiving 2-weekly durvalumab, the rate of grade 3 and 4 toxicities was 15 % compared to 7% in patients receiving 4-weekly durvalumab. Pre-existing autoimmune disease was considered a risk factor for the development of grade 3 or 4 toxicities. We did not observe any difference in the rate of grade 1 and 2 toxicities between the two groups. Our findings support the use of 4-weekly durvalumab during the COVID-19 pandemic and beyond, obviating the need for 2-weekly face-to-face consultations and blood tests, relevant given the current pandemic and the need to re-structure cancer services to minimise patient hospital visits and exposure to SARS-CoV-2.