Concurrent Chemoradiation With or Without Durvalumab in Elderly Patients With Unresectable Stage III NSCLC: Safety and Efficacy
Introduction: The addition of durvalumab after chemoradiation therapy (CRT) in unresectable stage III NSCLC significantly improves survival. The benefit of this approach in elderly patients is controversial given the toxicity associated with CRT and, thus, may be underutilized. We sought to investig...
| 出版年: | JTO Clinical and Research Reports |
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| 主要な著者: | , , , , , , , , , , , , , , , , , , , , |
| フォーマット: | 論文 |
| 言語: | 英語 |
| 出版事項: |
Elsevier
2021-12-01
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| 主題: | |
| オンライン･アクセス: | http://www.sciencedirect.com/science/article/pii/S2666364321001107 |
| _version_ | 1856929607411826688 |
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| author | Sally C.M. Lau, MD, MPH Malcolm Ryan, BSc Jessica Weiss, PhD Aline Fusco Fares, MD Miguel Garcia, MD Sabine Schmid, MD Shelley Kuang, MD Deirdre Kelly, MB BCh BAO Ming Sound Tsao, MD Penelope A. Bradbury, MB BCh Byoung Chun J. Cho, MD Alexander Sun, MD Srinivas Raman, MD Andrew Hope, MD Meredith Giuliani, MBBS, MEd, PhD Benjamin H. Lok, MD, PhD Andrea Bezjak, MD Geoffrey Liu, MD, MSc Natasha B. Leighl, MD, MSc Frances A. Shepherd, MD Adrian G. Sacher, MD, MMSc |
| author_facet | Sally C.M. Lau, MD, MPH Malcolm Ryan, BSc Jessica Weiss, PhD Aline Fusco Fares, MD Miguel Garcia, MD Sabine Schmid, MD Shelley Kuang, MD Deirdre Kelly, MB BCh BAO Ming Sound Tsao, MD Penelope A. Bradbury, MB BCh Byoung Chun J. Cho, MD Alexander Sun, MD Srinivas Raman, MD Andrew Hope, MD Meredith Giuliani, MBBS, MEd, PhD Benjamin H. Lok, MD, PhD Andrea Bezjak, MD Geoffrey Liu, MD, MSc Natasha B. Leighl, MD, MSc Frances A. Shepherd, MD Adrian G. Sacher, MD, MMSc |
| author_sort | Sally C.M. Lau, MD, MPH |
| collection | DOAJ |
| container_title | JTO Clinical and Research Reports |
| description | Introduction: The addition of durvalumab after chemoradiation therapy (CRT) in unresectable stage III NSCLC significantly improves survival. The benefit of this approach in elderly patients is controversial given the toxicity associated with CRT and, thus, may be underutilized. We sought to investigate the outcomes of elderly patients treated with CRT without or without durvalumab at our center. Methods: We reviewed all stage III patients with NSCLC treated with CRT between 2018 and 2020. Patients were analyzed on the basis of age: less than 70 years and 70 years and older. The end points evaluated were treatment patterns, toxicity, progression-free survival, and overall survival. Results: The baseline characteristics including Eastern Cooperative Oncology Group performance status and comorbidities were similar among the 115 patients (44 elderly, 71 young). Completion rates of CRT (100%, 97%) and chemotherapy dose intensity (97%, 97%) were high in elderly and young patients, respectively. There was a trend toward increased hospitalizations in elderly patients because of infections (27% versus 13%, p = 0.08). Of those who did not have primary progression after CRT, 78% of eldery and 81% of young patients received durvalumab. The incidence of grade 3 or higher immune-related adverse events was 9% in elderly and 6% in young patients (p = 0.67). The median progression-free survival was similar (15.6 versus 10.5 mo, p = 0.10), even after adjusting for comorbidities (hazard ratio = 0.6, p = 0.09). The 12-month overall survival rates were 78% in the elderly and 76% in young patients (p = 0.98). Conclusions: Well-selected elderly patients can be treated safely with CRT followed by durvalumab with similar survival benefits compared with their younger counterparts. We would advocate for the referral of all elderly patients for oncologic assessment to avoid undertreatment. |
| format | Article |
| id | doaj-art-eafc28dbd2bc49cd99b777e1bd11e394 |
| institution | Directory of Open Access Journals |
| issn | 2666-3643 |
| language | English |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| spelling | doaj-art-eafc28dbd2bc49cd99b777e1bd11e3942025-08-19T20:13:51ZengElsevierJTO Clinical and Research Reports2666-36432021-12-0121210025110.1016/j.jtocrr.2021.100251Concurrent Chemoradiation With or Without Durvalumab in Elderly Patients With Unresectable Stage III NSCLC: Safety and EfficacySally C.M. Lau, MD, MPH0Malcolm Ryan, BSc1Jessica Weiss, PhD2Aline Fusco Fares, MD3Miguel Garcia, MD4Sabine Schmid, MD5Shelley Kuang, MD6Deirdre Kelly, MB BCh BAO7Ming Sound Tsao, MD8Penelope A. Bradbury, MB BCh9Byoung Chun J. Cho, MD10Alexander Sun, MD11Srinivas Raman, MD12Andrew Hope, MD13Meredith Giuliani, MBBS, MEd, PhD14Benjamin H. Lok, MD, PhD15Andrea Bezjak, MD16Geoffrey Liu, MD, MSc17Natasha B. Leighl, MD, MSc18Frances A. Shepherd, MD19Adrian G. Sacher, MD, MMSc20Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, CanadaDepartment of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, CanadaDepartment of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, CanadaDepartment of Medical Oncology, Faculty of Medicine, Hospital de Base de São José do Rio Preto, Sao Paulo, BrazilDepartment of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, CanadaDepartment of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, CanadaDepartment of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, CanadaDepartment of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, CanadaDepartment of Pathology, Laboratory Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, CanadaDepartment of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, CanadaRadiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, CanadaDepartment of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, CanadaDepartment of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, CanadaDepartment of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, CanadaDepartment of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; Department of Immunology, Faculty of Medicine, University of Toronto, Toronto, Canada; Corresponding author. Address for correspondence: Adrian G Sacher, MD, Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 610 University Avenue, Toronto ON M5G 2M9, Canada.Introduction: The addition of durvalumab after chemoradiation therapy (CRT) in unresectable stage III NSCLC significantly improves survival. The benefit of this approach in elderly patients is controversial given the toxicity associated with CRT and, thus, may be underutilized. We sought to investigate the outcomes of elderly patients treated with CRT without or without durvalumab at our center. Methods: We reviewed all stage III patients with NSCLC treated with CRT between 2018 and 2020. Patients were analyzed on the basis of age: less than 70 years and 70 years and older. The end points evaluated were treatment patterns, toxicity, progression-free survival, and overall survival. Results: The baseline characteristics including Eastern Cooperative Oncology Group performance status and comorbidities were similar among the 115 patients (44 elderly, 71 young). Completion rates of CRT (100%, 97%) and chemotherapy dose intensity (97%, 97%) were high in elderly and young patients, respectively. There was a trend toward increased hospitalizations in elderly patients because of infections (27% versus 13%, p = 0.08). Of those who did not have primary progression after CRT, 78% of eldery and 81% of young patients received durvalumab. The incidence of grade 3 or higher immune-related adverse events was 9% in elderly and 6% in young patients (p = 0.67). The median progression-free survival was similar (15.6 versus 10.5 mo, p = 0.10), even after adjusting for comorbidities (hazard ratio = 0.6, p = 0.09). The 12-month overall survival rates were 78% in the elderly and 76% in young patients (p = 0.98). Conclusions: Well-selected elderly patients can be treated safely with CRT followed by durvalumab with similar survival benefits compared with their younger counterparts. We would advocate for the referral of all elderly patients for oncologic assessment to avoid undertreatment.http://www.sciencedirect.com/science/article/pii/S2666364321001107ElderlyChemoradiotherapyImmune checkpoint inhibitorsMultimodality treatmentSafety |
| spellingShingle | Sally C.M. Lau, MD, MPH Malcolm Ryan, BSc Jessica Weiss, PhD Aline Fusco Fares, MD Miguel Garcia, MD Sabine Schmid, MD Shelley Kuang, MD Deirdre Kelly, MB BCh BAO Ming Sound Tsao, MD Penelope A. Bradbury, MB BCh Byoung Chun J. Cho, MD Alexander Sun, MD Srinivas Raman, MD Andrew Hope, MD Meredith Giuliani, MBBS, MEd, PhD Benjamin H. Lok, MD, PhD Andrea Bezjak, MD Geoffrey Liu, MD, MSc Natasha B. Leighl, MD, MSc Frances A. Shepherd, MD Adrian G. Sacher, MD, MMSc Concurrent Chemoradiation With or Without Durvalumab in Elderly Patients With Unresectable Stage III NSCLC: Safety and Efficacy Elderly Chemoradiotherapy Immune checkpoint inhibitors Multimodality treatment Safety |
| title | Concurrent Chemoradiation With or Without Durvalumab in Elderly Patients With Unresectable Stage III NSCLC: Safety and Efficacy |
| title_full | Concurrent Chemoradiation With or Without Durvalumab in Elderly Patients With Unresectable Stage III NSCLC: Safety and Efficacy |
| title_fullStr | Concurrent Chemoradiation With or Without Durvalumab in Elderly Patients With Unresectable Stage III NSCLC: Safety and Efficacy |
| title_full_unstemmed | Concurrent Chemoradiation With or Without Durvalumab in Elderly Patients With Unresectable Stage III NSCLC: Safety and Efficacy |
| title_short | Concurrent Chemoradiation With or Without Durvalumab in Elderly Patients With Unresectable Stage III NSCLC: Safety and Efficacy |
| title_sort | concurrent chemoradiation with or without durvalumab in elderly patients with unresectable stage iii nsclc safety and efficacy |
| topic | Elderly Chemoradiotherapy Immune checkpoint inhibitors Multimodality treatment Safety |
| url | http://www.sciencedirect.com/science/article/pii/S2666364321001107 |
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