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Multicenter Study
. 2023 Jan 20;64(1):142-153.
doi: 10.1093/jrr/rrac057.

Recurrence patterns and progression-free survival after chemoradiotherapy with or without consolidation durvalumab for stage III non-small cell lung cancer

Noriko Kishi  1 , Yukinori Matsuo  1 , Takashi Shintani  2 , Masakazu Ogura  3 , Takamasa Mitsuyoshi  4 , Norio Araki  5 , Kota Fujii  6 , Setsuko Okumura  7 , Kiyoshi Nakamatsu  8 , Takahiro Kishi  9 , Tomoko Atsuta  10 , Takashi Sakamoto  11 , Shuji Ohtsu  12 , Tomohiro Katagiri  13 , Masaru Narabayashi  2 , Satsuki Fujishiro  14 , Yusuke Iizuka  15 , Hiroaki Ozasa  16 , Toyohiro Hirai  16 , Takashi Mizowaki  1 ; Kyoto Radiation Oncology Study Group (KROSG)
Affiliations
Multicenter Study

Recurrence patterns and progression-free survival after chemoradiotherapy with or without consolidation durvalumab for stage III non-small cell lung cancer

Noriko Kishi et al. J Radiat Res. .

Abstract

Chemoradiotherapy followed by consolidation durvalumab (CCRT+D) improves survival in patients with stage III non-small-cell lung cancer (NSCLC). We compared recurrence patterns and survival in the CCRT+D and CCRT cohorts. We conducted a multicenter, retrospective study in Japan. Patients who received CCRT for stage III NSCLC were included in this study. Of 178 eligible patients, 136 were in the CCRT+D and 42 were in the CCRT cohorts. Locoregional recurrence (LR), LR plus distant metastases (DM), and DM were observed in 20.6%, 8.8%, 27.9% of the CCRT+D, and 26.2%, 16.7% and 33.3% of the CCRT cohorts, respectively. In-field recurrence was the most common LR pattern in both cohorts. Squamous cell carcinoma and PD-L1 expression < 1%, and female sex and EGFR mutations were significantly associated with an increased risk of LR and DM. In patients with any risk factors for LR, the incidence of LR was similar in the CCRT+D and CCRT (39.5% vs 45.5%). The 24 month progression-free survival (PFS) and overall survival (OS) were 40.3% and 69.4% in the CCRT+D and 24.7% and 61.0% in the CCRT cohorts, respectively. Poor performance status and no consolidation durvalumab were significantly associated with shorter PFS. There was a significant difference in PFS between the CCRT+D and CCRT in the propensity score-matched cohort (HR = 0.51, P = 0.005). In conclusion, consolidation durvalumab decreased both LR and DM, and significantly improved PFS. However, in-field recurrence was still a major problem, as well as DM.

Keywords: distant metastasis; immunotherapy; locoregional recurrence (LR); real-world data.

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Figures

Fig. 1
Fig. 1
The patterns of initial recurrence in the chemoradiotherapy and consolidation durvalumab (CCRT+D) cohort and the CCRT cohort. Abbreviations: LR, locoregional recurrence; DM, distant metastasis; NED, no evidence of disease; IF, in-field recurrence; EF, elective field recurrence; OF, out-of-field recurrence.
Fig. 2
Fig. 2
Kaplan–Meier curve of (a) PFS and (b) OS in chemoradiotherapy (CCRT) with durvalumab cohort versus CCRT cohort.
Fig. 3
Fig. 3
(a) Patterns of initial recurrence and (b) PFS in patients at high risk of local recurrence (squamous cell carcinoma or PD-L1 expression status < 1%), and (c and d) those at high risk of distant metastasis (female or EGFR mutation). The abbreviations are the same as shown in Fig. 2.
Fig. 3
Fig. 3
(a) Patterns of initial recurrence and (b) PFS in patients at high risk of local recurrence (squamous cell carcinoma or PD-L1 expression status < 1%), and (c and d) those at high risk of distant metastasis (female or EGFR mutation). The abbreviations are the same as shown in Fig. 2.
Fig. 4
Fig. 4
Kaplan–Meier curves of (a) PFS and (b) OS in CCRT with consolidation durvalumab cohort and CCRT cohort after propensity-score matched analysis.
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