A study of the efficacy and toxicity outcomes of extended durvalumab dosing in patients with stage III unresectable non-small cell lung cancer (NSCLC) during the COVID-19 pandemic. (2023)

• Record Type: Journal Article
• Authors: Hanna, Lilian; Moffat, Gordon Taylor; Hopman, Wilma; Gaudreau, Pierre-Olivier; Fung, Andrea S.
• Is Part Of: Cancer treatment and research communications. Number 34(2023)
• Publication Date: 2023
• DOI: 10.1016/j.ctarc.2022.100678
• Languages: English
• ISSNs: 2468-2942

Abstract

Highlights: Durvalumab post chemoradiation in stage III NSCLC has improved outcomes. Cancer patients are vulnerable to COVID-19 complications. Reducing medical visits during the COVID-19 pandemic became imperative to decrease risks of exposure for cancer patients. Extended dosing of durvalumab was equally efficacious to standard dosing. Extended dosing of durvalumab has similar toxicity to standard dosing. Abstract: Background: Durvalumab following chemoradiation in unresectable stage III non-small cell lung cancer (NSCLC) has led to improved outcomes. The schedule of administration has been determined by pharmacokinetic studies. This study evaluates real-world efficacy and safety outcomes of extended dosing (ED) vs. standard dosing (SD) of durvalumab. Methods: Stage III NSCLC patients treated at the Cancer center of Southeastern Ontario with consolidative durvalumab from March 2017-December 2020 were included. Patient characteristics and outcomes were evaluated through retrospective review. Comparisons were made using chi-square and t-tests. Kaplan-Meier curves were used to analyze overall survival (OS). Results: A total of 35 patients were included; 15 (43%) switched to ED. Distant recurrence rates were higher in the ED group (53% vs. 20%, p = 0.07), with no differences in the sites of disease recurrence. A similar proportion of patients were alive in the ED vs. SD group (93% vs. 80%, p = 0.3), with no significant difference in OS. There were less grade 3 or greater immune-related adverse events in the ED group (0% vs. 20%). Treatment discontinuation occurred in 47% vs. 50% in the ED vs. SD groups, respectively, owing to toxicity in 20% of patients in the ED group vs. 40% in the SD group. Conclusions: Extended dosing has similar efficacy and toxicity to standard dosing; however, there was a higher rate of toxicity necessitating discontinuation in the SD group, which may have impacted the clinical decision-making to switch to ED. Our data is limited by a small sample size and should be further validated in larger cohorts.