Top Line: It’s hard to top the local control achieved with today’s lung stereotactic body radiation (SBRT).
The Study: The problem is that many patients experience nodal or distant failure, particularly when employing empiric SBRT for presumed early-stage lung cancer absent invasive nodal staging. This phase 1/2 trial asked if the addition of durvalumab to SBRT for biopsy-proven stage I-IIA non-small cell lung cancer (NSCLC) is a promising strategy to improve overall disease control. All 18 enrollees were deemed medically inoperable or declined surgery and received durvalumab x 1 cycles followed by SBRT approximately 5 days later followed by an additional 4 cycles of durvalumab q4 weeks. SBRT was prescribed 54 Gy in 3 fractions when possible (n=16), with 50 Gy in 4 fractions (n=1) and, as a last alternative, 65 Gy in 10 fractions (n=1) depending on tumor centrality. At 2 years local control was 94%. More impressive was overall disease control of 84% at 2 years. Overall survival at 2 years was 89%. There were six grade 3+ toxicities, primarily lung (n=5), including one grade 5 event in a patient with previously undiagnosed interstitial lung diagnosis.
TBL: | Wu, Int J Radiat Oncol Biol Phys 2023
The Study: The problem is that many patients experience nodal or distant failure, particularly when employing empiric SBRT for presumed early-stage lung cancer absent invasive nodal staging. This phase 1/2 trial asked if the addition of durvalumab to SBRT for biopsy-proven stage I-IIA non-small cell lung cancer (NSCLC) is a promising strategy to improve overall disease control. All 18 enrollees were deemed medically inoperable or declined surgery and received durvalumab x 1 cycles followed by SBRT approximately 5 days later followed by an additional 4 cycles of durvalumab q4 weeks. SBRT was prescribed 54 Gy in 3 fractions when possible (n=16), with 50 Gy in 4 fractions (n=1) and, as a last alternative, 65 Gy in 10 fractions (n=1) depending on tumor centrality. At 2 years local control was 94%. More impressive was overall disease control of 84% at 2 years. Overall survival at 2 years was 89%. There were six grade 3+ toxicities, primarily lung (n=5), including one grade 5 event in a patient with previously undiagnosed interstitial lung diagnosis.
TBL: | Wu, Int J Radiat Oncol Biol Phys 2023