TY - JOUR
T1 - Real world efficacy and toxicity of consolidation durvalumab following chemoradiotherapy in older Australian patients with unresectable stage III non-small cell lung cancer
AU - Stevens, Samuel
AU - Nindra, Udit
AU - Shahnam, Adel
AU - Wei, Joe
AU - Bray, Victoria
AU - Pal, Abhijit
AU - Yip, Po Yee
AU - Linton, Anthony
AU - Blinman, Prunella
AU - Nagrial, Adnan
AU - Lee, Jenny
AU - Boyer, Michael
AU - Kao, Steven
N1 - Copyright the Author(s) 2024. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 2024/3
Y1 - 2024/3
N2 - Introduction: Consolidation durvalumab following platinum-based chemoradiotherapy (CRT) significantly improved overall survival for patients with unresectable stage III non-small cell lung cancer (NSCLC) in the PACIFIC trial. However, older patients were underrepresented in PACIFIC, and subsequent analyses suggested trends toward poorer survival and increased toxicity in patients aged ≥70 years old. We assessed the effectiveness and safety of consolidation durvalumab following CRT in older Australian patients with unresectable stage III NSCLC. Materials and Methods: This retrospective observational study was conducted across seven sites in Sydney, Australia between January 2018 and September 2021. All adult patients with unresectable stage III NSCLC who received platinum-based chemoradiotherapy followed by at least one cycle of consolidation durvalumab were included. Older patients were defined as being ≥70 years old. Results: Of 152 patients included in the analysis, 42.8% (n = 67) patients were 70 years or older. Median follow-up was 26.1 months. The two-year overall survival and median PFS was similar between older and younger patients. At two years, 74.8% (95% confidence interval [CI]: 65.4–84.2%) of patients <70 years old and 65.2% (95% CI: 53.4–77.0%) of older patients were alive (p = 0.07; hazard ratio [HR] 1.64, 95% CI: 0.95–2.81). Median progression-free survival (PFS) in patients <70 years was 30.3 months (95% CI: 22.2–38.4 months) compared with 26.7 months (95% CI: 12.8–40.6 months) in older patients (p = 0.22; HR 1.46, 95% CI: 0.80–2.65). Toxicity was also similar, with 11.5% of patients <70 years old and 18.5% of older patients experiencing grade 3–4 adverse events (AEs; p = 0.23); 16.1% and 24.6% of the patients, respectively, discontinued treatment due to toxicity (p = 0.19). Grade 3–4 AEs and treatment discontinuation were associated with Charlson Comorbidity Index >5 (p = 0.011) and chronic obstructive pulmonary disease diagnosis at presentation (p = 0.002), respectively. Discussion: Older Australian patients receiving consolidation durvalumab following CRT experienced comparable outcomes to their younger peers. Comorbidity burden may be more important determinants of treatment tolerance than chronological age.
AB - Introduction: Consolidation durvalumab following platinum-based chemoradiotherapy (CRT) significantly improved overall survival for patients with unresectable stage III non-small cell lung cancer (NSCLC) in the PACIFIC trial. However, older patients were underrepresented in PACIFIC, and subsequent analyses suggested trends toward poorer survival and increased toxicity in patients aged ≥70 years old. We assessed the effectiveness and safety of consolidation durvalumab following CRT in older Australian patients with unresectable stage III NSCLC. Materials and Methods: This retrospective observational study was conducted across seven sites in Sydney, Australia between January 2018 and September 2021. All adult patients with unresectable stage III NSCLC who received platinum-based chemoradiotherapy followed by at least one cycle of consolidation durvalumab were included. Older patients were defined as being ≥70 years old. Results: Of 152 patients included in the analysis, 42.8% (n = 67) patients were 70 years or older. Median follow-up was 26.1 months. The two-year overall survival and median PFS was similar between older and younger patients. At two years, 74.8% (95% confidence interval [CI]: 65.4–84.2%) of patients <70 years old and 65.2% (95% CI: 53.4–77.0%) of older patients were alive (p = 0.07; hazard ratio [HR] 1.64, 95% CI: 0.95–2.81). Median progression-free survival (PFS) in patients <70 years was 30.3 months (95% CI: 22.2–38.4 months) compared with 26.7 months (95% CI: 12.8–40.6 months) in older patients (p = 0.22; HR 1.46, 95% CI: 0.80–2.65). Toxicity was also similar, with 11.5% of patients <70 years old and 18.5% of older patients experiencing grade 3–4 adverse events (AEs; p = 0.23); 16.1% and 24.6% of the patients, respectively, discontinued treatment due to toxicity (p = 0.19). Grade 3–4 AEs and treatment discontinuation were associated with Charlson Comorbidity Index >5 (p = 0.011) and chronic obstructive pulmonary disease diagnosis at presentation (p = 0.002), respectively. Discussion: Older Australian patients receiving consolidation durvalumab following CRT experienced comparable outcomes to their younger peers. Comorbidity burden may be more important determinants of treatment tolerance than chronological age.
KW - Durvalumab
KW - Non-small cell lung cancer
KW - Older persons
KW - PACIFIC
KW - Stage 3
UR - http://www.scopus.com/inward/record.url?scp=85183929399&partnerID=8YFLogxK
U2 - 10.1016/j.jgo.2024.101705
DO - 10.1016/j.jgo.2024.101705
M3 - Article
C2 - 38290173
AN - SCOPUS:85183929399
SN - 1879-4068
VL - 15
SP - 1
EP - 9
JO - Journal of Geriatric Oncology
JF - Journal of Geriatric Oncology
IS - 2
M1 - 101705
ER -