Merle Ronden, MD Department of Radiation Oncology, VU University Medical Center speaks about The Impact of the Availability of Immunotherapy on Patterns of Care in Stage III NSCLC: A Dutch Multicenter Analysis.
Link to Abstract:
https://www.jtocrr.org/article/S2666-3643(21)00054-0/fulltext
Overview:
Intro:
Treatment for stage III NSCLC varies a lot from country to country. Adjuvant durvalumab following concurrent chemoradiotherapy improved progression-free and overall survival in the PACIFIC study (CCRT). Between 2015 and 2019, we looked at treatment decisions made by three Dutch regional thoracic multidisciplinary tumor boards to see if there were any changes in practice when adjuvant durvalumab became accessible.
Methodologies:
Patients with stage III NSCLC had their information obtained retrospectively. Radiation-intent therapy was characterized as CCRT and multimodality schemes that included planned surgery (RIT).
Findings:
A thoracic multidisciplinary tumor board discussed the majority of the 855 eligible patients (95%) and recommended a RIT in 63 percent (n = 510). Only 52 percent of the patients (n = 424) obtained a RIT. Age greater than or equal to 70 years, WHO performance score greater than or equal to 2, Charlson comorbidity index greater than or equal to 2 (excluding age), forced expiratory volume in 1 second less than 80% of predicted value, N3 disease, and period of diagnosis were all predictors for not recommending RIT. Between 2015 and 2017, the proportion of patients receiving CCRT grew from 34% to 42% (p = 0.02), whereas the usage of sequential chemoradiotherapy decreased (from 21% to 16%) (p = 0.05). For both periods, the rates of early toxicity and 1-year death were comparable. Adjuvant durvalumab was given to 57 percent of patients who had CCRT after 2018 (90 of 159).
Outcomes:
Following the release of the PACIFIC study, the usage of CCRT for patients with stage III NSCLC increased significantly, but early toxicity and death rates remained similar. Since 2018, 57 percent of CCRT patients have received adjuvant durvalumab treatment. Despite this, around half of the patients were still deemed unsuitable for a RIT.