Aims
The standard of care for the treatment of unresectable locally advanced patients with non-small cell lung cancer (NSCLC) is concurrent chemoradiotherapy followed by consolidation durvalumab for 12 months. There is a paucity of data investigating the treatments and outcomes of patients who have progressed post receiving durvalumab thus our study aimed to describe the patterns of care in this population group.
Methods:
This retrospective observation study across 5 cancers centers in Sydney Australia included any patient with locally advanced unresectable NSCLC treated with chemoradiation and who received at least 1 dose of durvalumab between January 2018 and September 2021. Progression free survival 1 (PFS1) was defined as the time of diagnosis to the date of first progression and PFS2 was defined as date of relapse to the time of second progression or death whichever came first. PFS was estimated using the Kaplan Meier method.
Results
99 patients were identified. Median age was 66, majority were male (62%) and had a smoking history (82%). After median follow up of 25.6 month, 43 patients had progression corresponding to a median PFS1 of 13.8 months. The most common site of relapse was thoracic (n=24), CNS (n=8), visceral (n=6) and skeletal (n=4). Of the 43 patients who progressed, 34 received subsequent therapy whilst 8 were for best supportive care (BSC). Subsequent treatments included surgery (n=2), radiotherapy (n=6) and systemic therapy (n=26). The most utilized systemic therapy was chemotherapy (n=13) followed by targeted therapy (n=9), immunotherapy (n=3) and clinical trial (n=1). The overall median PFS2 was 7.2 months. Median PFS2 was 3.9 months for patients with BSC, 5.2 months for patient receiving local therapy and 7.5 months for patients treated systemically.
Conclusion
NSCLC patients who progress post durvalumab have limited treatment options and overall poor prognosis highlighting an area of need for future research.