Durvalumab Treatment Patterns for Patients with Unresectable Stage III Non-Small Cell Lung Cancer in the Veterans Health Administration (VHA): A Nationwide, Real-World Study

Amanda M. Moore, Zohra Nooruddin, Kelly R. Reveles, Paromita Datta, Jennifer M. Whitehead, Kathleen Franklin, Munaf Alkadimi, Madison H. Williams, Ryan A. Williams, Sarah Smith, Renee Reichelderfer, Ion Cotarla, Lance Brannman, Andrew Frankart, Tiernan Mulrooney, Kristin Hsieh, Daniel J. Simmons, Xavier Jones, Christopher R. Frei

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Durvalumab is approved for the treatment of adults with unresectable stage III non-small cell lung cancer (NSCLC) post-chemoradiotherapy (CRT). This real-world study describes patient characteristics and durvalumab treatment patterns (number of doses and therapy duration; treatment initiation delays, interruptions, discontinuations, and associated reasons) among VHA-treated patients. Methods: This was a retrospective cohort study of adults with unresectable stage III NSCLC receiving durvalumab at the VHA between 1 January 2017 and 30 June 2020. Patient characteristics and treatment patterns were presented descriptively. Results: A total of 935 patients were included (median age: 69 years; 95% males; 21% Blacks; 46% current smokers; 16% ECOG performance scores ≥ 2; 50% squamous histology). Durvalumab initiation was delayed in 39% of patients (n = 367). Among the 200 patients with recorded reasons, delays were mainly due to physician preference (20%) and CRT toxicity (11%). Overall, patients received a median (interquartile range) of 16 (7–24) doses of durvalumab over 9.0 (2.9–11.8) months. Treatment interruptions were experienced by 19% of patients (n = 180), with toxicity (7.8%) and social reasons (2.6%) being the most cited reasons. Early discontinuation occurred in 59% of patients (n = 551), largely due to disease progression (24.2%) and toxicity (18.2%). Conclusions: These real-world analyses corroborate PACIFIC study results in terms of the main reasons for treatment discontinuation in a VHA population with worse prognostic factors, including older age, predominantly male sex, and poorer performance score. One of the main reasons for durvalumab initiation delays, treatment interruptions, or discontinuations was due to toxicities. Patients could benefit from improved strategies to prevent, identify, and manage CRT and durvalumab toxicities timely and effectively.

Original languageEnglish (US)
Pages (from-to)8411-8423
Number of pages13
JournalCurrent Oncology
Volume30
Issue number9
DOIs
StatePublished - Sep 2023
Externally publishedYes

Keywords

  • chemoradiotherapy
  • chemotherapy
  • durvalumab
  • immunotherapy
  • lung cancer
  • pharmacoepidemiology
  • radiotherapy
  • stage III NSCLC

ASJC Scopus subject areas

  • Oncology

Fingerprint

Dive into the research topics of 'Durvalumab Treatment Patterns for Patients with Unresectable Stage III Non-Small Cell Lung Cancer in the Veterans Health Administration (VHA): A Nationwide, Real-World Study'. Together they form a unique fingerprint.

Cite this