Top Line: Has pneumonitis risk increased in the era of adjuvant immunotherapy for locally advanced lung cancer?
The Study: The PACIFIC trial established the role of maintenance durvalumab following chemoradiation for locally advanced NSCLC. In PACIFIC, there was no significant increase in the rate of grade 3+ radiation pneumonitis with durvalumab (3.4% v 2.6%). This retrospective study took a look at 783 patients treated before (n=448) or after (n=335) the introduction of adjuvant durvalumab. While they found no difference in the rate of grade 3 pneumonitis with or without durvalumab (7.5% v 6.0%), there was a higher rate of grade 2 pneumonitis (31.4% v 20.1%). They also found that mean lung dose and lung V20 values from radiation plans were similar with and without durvalumab. However, grade 2 pneumonitis was higher with durvalumab in the upper range of normal V20’s (>24%) and mean lung doses (>14 Gy). In the setting of durvalumab, the rate of grade 2 pneumonitis was 46% when the V20 was >28% compared to 19.8% when the V20 was <28%.
TBL: This retrospective study found similar rates of grade 3 pneumonitis but higher grade 2 pneumonitis in patients treated with adjuvant durvalumab for NSCLC. Slightly more conservative lung dose constraints may help reduce the risk of developing grade 2 pneumonitis. | Yegya-Raman, Int J Radiat Oncol Biol Phys 2023
The Study: The PACIFIC trial established the role of maintenance durvalumab following chemoradiation for locally advanced NSCLC. In PACIFIC, there was no significant increase in the rate of grade 3+ radiation pneumonitis with durvalumab (3.4% v 2.6%). This retrospective study took a look at 783 patients treated before (n=448) or after (n=335) the introduction of adjuvant durvalumab. While they found no difference in the rate of grade 3 pneumonitis with or without durvalumab (7.5% v 6.0%), there was a higher rate of grade 2 pneumonitis (31.4% v 20.1%). They also found that mean lung dose and lung V20 values from radiation plans were similar with and without durvalumab. However, grade 2 pneumonitis was higher with durvalumab in the upper range of normal V20’s (>24%) and mean lung doses (>14 Gy). In the setting of durvalumab, the rate of grade 2 pneumonitis was 46% when the V20 was >28% compared to 19.8% when the V20 was <28%.
TBL: This retrospective study found similar rates of grade 3 pneumonitis but higher grade 2 pneumonitis in patients treated with adjuvant durvalumab for NSCLC. Slightly more conservative lung dose constraints may help reduce the risk of developing grade 2 pneumonitis. | Yegya-Raman, Int J Radiat Oncol Biol Phys 2023