Factors influencing decision-making in relation to the administration of durvalumab after chemoradiotherapy (TOPGAN2020-01)

Abstract

Objective. In clinical practice, durvalumab has been used as a standard maintenance treatment after chemoradiotherapy (CRT) for locally advanced non-small cell lung cancer (NSCLC). However, it is unknown as to how often practitioners avoid using durvalumab. The present study aimed to analyze the factors that influence decision-making in relation to the administration of durvalumab. Methods. We retrospectively analyzed the treatment of locally advanced NSCLC in 12 hospitals with lung cancer specialists. We evaluated patients with NSCLC who were treated with CRT from May 2018 to December 2019 and compared the characteristics between patients who received durvalumab and those who did not. We also conducted a questionnaire-based survey to determine the reasons for avoiding durvalumab. Results. Among 199 patients who received CRT, durvalumab was administered to 169 patients (84.9%). The median age of the patients in the non-administration group was significantly higher than that in the administration group (70 vs. 67 years, p=0.0465), and the performance status (PS) ≥ 1 in the non-administration group was significantly higher than that in the administration group (65.5 vs. 40.4%, p =0.0148). According to the questionnaire responses, durvalumab administration was avoided for the following reasons: adverse events due to CRT (n=7); patient needs (n=5); disease progression (n=4); poor PS (n=3); driver mutation of NSCLC (n=3); and complications of autoimmune disease (n=2). Conclusion. Durvalumab was administered to 84.9% of patients in this study. Each practitioner considered age, PS, adverse events due to CRT, and driver mutations of NSCLC, before prescribing durvalumab.