Clinical and radiation dose-volume factors related to pneumonitis after treatment with radiation and durvalumab in local
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SHORT REPORT
Clinical and radiation dose-volume factors related to pneumonitis after treatment with radiation and durvalumab in locally advanced non-small cell lung cancer Hiroto Inoue 1 & Akira Ono 1 & Takanori Kawabata 2 & Nobuaki Mamesaya 1 & Takahisa Kawamura 1 & Haruki Kobayashi 1 & Shota Omori 1 & Kazushige Wakuda 1 & Hirotsugu Kenmotsu 1 & Tateaki Naito 1 & Haruyasu Murakami 1 & Kazuaki Yasui 3 & Hirofumi Ogawa 3 & Tsuyoshi Onoe 3 & Masahiro Endo 4 & Hideyuki Harada 3 & Toshiaki Takahashi 1 Received: 17 January 2020 / Accepted: 25 February 2020 # The Author(s) 2020
Summary Introduction Durvalumab has been shown to confer a survival benefit after definitive chemoradiotherapy in the patients with locally advanced non-small cell lung cancer, but no studies have attempted to identify risk factors for pneumonitis after durvalumab therapy. The purpose of this study was to investigate associations between clinical and radiation dose-volume factors, and the severity of pneumonitis. Methods We retrospectively assessed the cases of 30 patients who had been started on durvalumab therapy between July 2018 and February 2019. In this study we evaluated the percentage of lung volume receiving radiation dose in excess of 20 Gy (V20) as radiation dose-volume factor. We compared V20 and some baseline factors between a grade 0 or 1 (Gr 0/1) pneumonitis group and a grade 2 or more (≥Gr 2) pneumonitis group, and we performed a logistic regression analysis to establish the associations between variables and ≥ Gr 2 pneumonitis. Results Pneumonitis had developed in 22 patients (73.3%): Gr 1/2/3–5 in 8 (26.7%)/14 (46.7%) /0 (0%), respectively. The difference in V20 between the Gr 0/1 group and Gr 2 group (median: 20.5% vs. 23.5%, p = 0.505) was not statistically significant, and thus V20 was not a risk factor for Gr 2 pneumonitis (odds ratio: 1.047, p = 0.303). None of the clinical factors, including sex, age, smoking history, presence of baseline pneumonitis, type of radiation therapy, location of lesion and facility, were risk factors. Conclusions Our study suggest that the severity of pneumonitis after durvalumab is unrelated to V20 or any of the clinical factors assessed in this study. Keywords Durvalumab . Chemoradiotherapy . Pneumonitis . Risk factor . V20 . Locally advanced non-small cell lung cancer
Introduction Definitive concurrent chemoradiotherapy (CRT) is a standard treatment for unresectable locally advanced non-small cell lung carcinoma (NSCLC). Preclinical studies have shown that
* Akira Ono [email protected] 1
Division of Thoracic Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka 411-8777, Japan
2
Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
3
Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan
4
Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
radiation therapy synergistically enhances the antitumor effects of immunotherapy, such as with immune checkpoint inhibitors (ICIs), by increasing tumor infiltration
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