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- Original Article -

Factors Influencing Decision-making in Relation to the Administration of Durvalumab After Chemoradiotherapy (TOPGAN2020-01)

Ryo Ariyasu¹, Ken Uchibori¹, Hisashi Tanaka², Eisaku Miyauchi³, Yosuke Kawashima⁴, Fumiyoshi Ohyanagi⁵, Atsushi Horiike⁶, Toshio Sakatani⁷, Masafumi Saiki⁸, Yuichi Tambo⁹, Azusa Tanimoto¹⁰, Tomoaki Sonoda¹¹, Junji Koyama¹², Takeshi Uenami¹³, Keita Kudo¹⁴, Yuko Tsuchiya¹⁵, Makoto Nishio^1
1Department of Thoracic Medical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Japan, ²Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Japan, ³Department of Respiratory Medicine, Tohoku University Hospital, Japan, ⁴Department of Pulmonary Medicine, Sendai Kousei Hospital, Japan, ⁵Division of Pulmonary Medicine, Clinical Department of Internal Medicine, Jichi Medical University Saitama Medical Center, Japan, ⁶Division of Medical Oncology, Department of Medicine, Showa University School of Medicine, Japan, ⁷Division of Respirology, NTT Medical Center Tokyo, Japan, ⁸Department of Internal Medicine II, University of Yamanashi Faculty of Medicine, Japan, ⁹Department of Respiratory Medicine, ¹⁰Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Japan, ¹¹Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Japan, ¹²Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Japan, ¹³Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Japan, ¹⁴Department of Medical Oncology and Respiratory Medicine, National Hospital Organization Osaka Minami Medical Center, Japan, ¹⁵Department of Respiratory Medicine, Kitakyushu Municipal Medical Center, Japan

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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.
key words: Non-small cell lung cancer, Durvalumab, Chemoradiotherapy

Received: June 24, 2020
Accepted: September 8, 2020

JJLC 60 (7): 966-971, 2020