Forschung & Innovation
Publikationen
Durvalumab Is Associated with Prolonged Progression-Free Survival, While Concomitant Chemoradiotherapy May Improve Both Locoregional and Local Control in Elderly Patients with Unresectable NSCLC Stage III
PMU Autor*innen
Franz Zehentmayr, Josef Karner, Markus Stana, Elvis Ruznic, Barbara Zellinger, Raphaela Moosbrugger, Falk Roeder, Brane Grambozov
Alle Autor*innen
Franz Zehentmayr, Josef Karner, Markus Stana, Elvis Ruznic, Barbara Zellinger, Marisa Klebermass, Ayurzana Purevdorj, Georg Gruber, Danijela Minasch, Martin Heilmann, Raphaela Moosbrugger, Falk Roeder, Brane Grambozov
Fachzeitschrift
Medical Sciences
Kurzfassung
Introduction: The incidence of NSCLC increases with age, with a median of approximately 70 years at diagnosis. Historically, treatment strategies for locally advanced cancers have been developed predominantly in younger populations, often excluding elderly patients who may present with multiple comorbidities, severely impaired lung function, or decreased performance status, leading to a lack of age-relevant clinical data. Therefore, we performed a subanalysis of real-world data from the ALLSTAR study to investigate the impact of durvalumab and the radiation regimen (sequential versus concurrent) on clinical outcome in elderly patients with unresectable stage III NSCLC. Methods: We included a total of 171 patients in this subanalysis. All patients were diagnosed with unresectable stage III NSCLC. Patients were divided into two age groups, >= 70 (41%) and <70 years (59%). All of them received curative chemoradiotherapy with (66%) or without (34%) durvalumab. Results: Patients were followed up for a median time of 25.1 months (range: 3.3-52.1). In the elderly group, patients who did not receive durvalumab consolidation had a median PFS of 17 months (95%-CI: 12.4-not reached) and a higher risk of progression (HR = 2.2; 95%-CI: 1-4.6) than those treated with durvalumab, which had a median PFS of 37 months (95%-CI: 24.5-not reached). This difference was statistically significant (log rank p = 0.026). Moreover, the Cox model yielded a hazard ratio suggesting a higher risk of locoregional (HR = 3.8; 95%-CI: 1.28-11.48; log rank p-value =0.01) as well as local recurrence (HR = 5.5: 95%-CI: 1.67-18.1: p-value =0.002) in patients who received sequential chemoradiotherapy compared to those with concomitant chemoradiotherapy in the same age group. In an exploratory analysis based on a Mann-Whitney U test, we did not find significant difference in toxicity between the two age groups. Conclusions: Durvalumab was associated with prolonged progression-free survival, while concomitant radiotherapy showed a trend towards improvement in locoregional and local control in patients aged >= 70. There was no significant difference in treatment toxicity found in the exploratory Mann-Whitney U analysis between the two age groups.
Keywords
Elderly, NSCLC, Durvalumab, Radiation oncology, Sequential radiotherapy