The following is a summary of “Utilization and Factors Precluding Receipt of Checkpoint Inhibitor Consolidation for Stage III NSCLC in a Large US Academic Health System,” published in the July 2023 issue of the Clinical Lung Cancer by Yegya-Raman et al.
Researchers aimed to determine the proportion of patients with stage III non–small cell lung cancer (NSCLC) who initiate consolidation durvalumab or other immune checkpoint inhibitors (ICIs) following concurrent chemoradiation therapy (cCRT), as well as the reasons for nonreceipt and prognostic implications. They identified consecutive patients with unresectable stage III NSCLC treated with definitive CRT in a large academic health center in the United States between October 2017 and December 2021.
Patients were either administered ICIs for consolidation (ICI group) or were not (no-ICI group). The group’s baseline characteristics and overall survival (OS) were evaluated. Logistic regression was used to assess factors that predict nonreceipt of ICI. About 229 (69%) of 333 patients who completed CRT began consolidation ICIs, while 104 (31%) did not. Progressive disease after cCRT (N = 31, 9%), comorbidity or concurrent illness (N = 25, 8%), cCRT toxicity (N = 23, 7%; 19/23 pneumonitis), and EGFR/ALK alteration (N = 14, 4%) were the reasons for ICI nonreceipt. The no-ICI group had a poorer performance status and a higher incidence of pulmonary comorbidity at baseline.
A larger planning target volume was associated with progressive disease following cCRT, while a higher lung radiation dose was associated with cCRT toxicity. The median OS was 16 months in the group without ICI and 34.4 months in the group with ICI. In the no-ICI group, those with EGFR/ALK alterations had a superior OS (median 44.5 months) compared to those with progressive disease (median 5.8 months, P<0.001). About 31% of stage III NSCLC patients who completed cCRT did not receive consolidation ICIs. These patients have a dismal prognosis, particularly those with progressive disease following CRT.