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@ARTICLE{Eichkorn:166486,
author = {T. Eichkorn and F. Bozorgmehr and S. Regnery and L. A.
Dinges and A. Kudak$^*$ and N. Bougatf$^*$ and D. Weber and
P. Christopoulos and T. Muley and S. Kobinger and L. König
and J. Hörner-Rieber$^*$ and S. Adeberg and C. P. Heussel
and M. Thomas and J. Debus$^*$ and R. A. El Shafie},
title = {{C}onsolidation {I}mmunotherapy {A}fter {P}latinum-{B}ased
{C}hemoradiotherapy in {P}atients {W}ith {U}nresectable
{S}tage {III} {N}on-{S}mall {C}ell {L}ung
{C}ancer-{C}ross-{S}ectional {S}tudy of {E}ligibility and
{A}dministration {R}ates.},
journal = {Frontiers in oncology},
volume = {10},
issn = {2234-943X},
address = {Lausanne},
publisher = {Frontiers Media},
reportid = {DKFZ-2020-02929},
pages = {586449},
year = {2020},
abstract = {The PACIFC trial demonstrated a significant benefit of
durvalumab consolidation immunotherapy (CIT) after
definitive platinum-based chemoradiotherapy (P-CRT) for
survival in stage III non-small cell lung cancer (NSCLC). It
is unknown how many patients are eligible in clinical
practice to receive CIT according to PACIFIC criteria
compared to real administration rates and what influencing
factors are.We analyzed 442 patients with unresectable stage
III NSCLC who received P-CRT between 2009 and 2019 regarding
CIT eligibility rates according to PACIFIC criteria and
administration rates since drug approval.Sixty-four percent
of 437 patients were male, median age was 63 years
[interquartile range (IQR): 57-69]. The most common
histologic subtypes were adenocarcinoma $(42.8\%)$ and
squamous cell carcinoma $(41.1\%),$ most tumors were in
stage IIIB $(56.8\%).$ Mean PD-L1 tumor proportion score
(TPS) was $29.8\%$ (IQR: 1-60). The median total RT dose was
60 Gy (IQR: 60-66). Platinum component of P-CRT was evenly
distributed between cisplatin $(51.4\%)$ and carboplatin
$(48.6\%).$ $50.3\%$ of patients were eligible for CIT
according to PACIFIC criteria. Observed contraindications
were progressive disease according to RECIST $(32.4\%),$
followed by a PD-L1 TPS < $1\%$ $(22.3\%),$ pneumonitis
CTCAE ≥ 2 $(12.6\%)$ and others $(4.9\%).$ One year after
drug approval, $85.6\%$ of patients who were eligible
according to PACIFIC criteria actually received CIT. Time
interval between chemotherapy start and radiation therapy
start (OR 0.9, $95\%$ CI: [0.9; 1.0] p = 0.009) and probably
cisplatin as platinum-component of P-CRT (OR 1.5, $95\%$ CI:
[1.0; 2.4] p < 0.061) influence CIT eligibility. Highly
positive PD-L1 TPS $(≥50\%;$ (OR 2.4, $95\%$ CI: [1.3;
4.5] p = 0.004) was associated to a better chance for CIT
eligibility.Eighty-five percent of potentially eligible
patients received CIT one year after drug approval. Fifty
percent of patients did not meet PACIFIC criteria for
durvalumab eligibility, this was mainly caused by disease
progression during platinum-based CRT, followed by
therapy-related pneumonitis and PD-L1 TPS < $1\%$ (in view
of the EMA drug approval).},
keywords = {PACIFIC criteria (Other) / definitive platinum-based
chemoradiotherapy (Other) / durvalumab admission rate
(Other) / durvalumab eligibility rate (Other) / non-small
cell lung cancer stage III (Other)},
cin = {E050 / HD01},
ddc = {610},
cid = {I:(DE-He78)E050-20160331 / I:(DE-He78)HD01-20160331},
pnm = {315 - Imaging and radiooncology (POF3-315)},
pid = {G:(DE-HGF)POF3-315},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:33335856},
pmc = {pmc:PMC7736629},
doi = {10.3389/fonc.2020.586449},
url = {https://inrepo02.dkfz.de/record/166486},
}