Abstract：
BACKGROUND: It is unclear how the duration and tapering pattern of corticosteroid therapy for pneumonitis changed after the introduction of durvalumab consolidation therapy.
METHODS: We retrospectively evaluated the medical records of patients diagnosed with nonsmall cell lung cancer who received chemoradiotherapy between January 2014 and December 2020.
RESULTS: Data for 135 patients treated before durvalumab approval and 100 patients treated with durvalumab after its approval were analyzed. In both groups, more than 70% were male, with a median age of 66 y. Approximately 85% were smokers, and the most common tumor histology was adenocarcinoma. Most patients were treated with doses of 60 and 66 Gy (n = 127 [94%] vs. n = 95 [95%]). Among the patients treated with durvalumab, 57%, 38%, and 5% had grade 1, grade 2, and grade 3 pneumonitis; none had grade 4 or 5 pneumonitis. Patients treated with durvalumab exhibited a longer duration of corticosteroid therapy for pneumonitis (17 wk; range: 2-88 wk) than patients not treated with durvalumab (7 wk; range: 0.4-21 wk; P < 0.001). Pneumonitis relapse was more frequent in patients treated with durvalumab (n = 8; 23%) than in patients not treated with durvalumab (n = 2; 7%). Among the 8 patients treated with durvalumab, 2 had recurrent pneumonitis, 1 could not terminate corticosteroids.
CONCLUSIONS: Our data show that durvalumab prolongs the duration of corticosteroid therapy and increases the complexity of corticosteroid tapering patterns. This study can help manage pneumonitis caused by immune checkpoint inhibitors and other drugs used after chemoradiotherapy in routine practice and clinical trials.
METHODS: We retrospectively evaluated the medical records of patients diagnosed with nonsmall cell lung cancer who received chemoradiotherapy between January 2014 and December 2020.
RESULTS: Data for 135 patients treated before durvalumab approval and 100 patients treated with durvalumab after its approval were analyzed. In both groups, more than 70% were male, with a median age of 66 y. Approximately 85% were smokers, and the most common tumor histology was adenocarcinoma. Most patients were treated with doses of 60 and 66 Gy (n = 127 [94%] vs. n = 95 [95%]). Among the patients treated with durvalumab, 57%, 38%, and 5% had grade 1, grade 2, and grade 3 pneumonitis; none had grade 4 or 5 pneumonitis. Patients treated with durvalumab exhibited a longer duration of corticosteroid therapy for pneumonitis (17 wk; range: 2-88 wk) than patients not treated with durvalumab (7 wk; range: 0.4-21 wk; P < 0.001). Pneumonitis relapse was more frequent in patients treated with durvalumab (n = 8; 23%) than in patients not treated with durvalumab (n = 2; 7%). Among the 8 patients treated with durvalumab, 2 had recurrent pneumonitis, 1 could not terminate corticosteroids.
CONCLUSIONS: Our data show that durvalumab prolongs the duration of corticosteroid therapy and increases the complexity of corticosteroid tapering patterns. This study can help manage pneumonitis caused by immune checkpoint inhibitors and other drugs used after chemoradiotherapy in routine practice and clinical trials.
摘要：
背景：目前尚不清楚在引入durvalumab巩固治疗后，皮质类固醇治疗肺炎的持续时间和逐渐减少的模式如何变化。
方法：我们回顾性评估了2014年1月至2020年12月间接受放化疗的诊断为非小细胞肺癌患者的病历。
结果：分析了在durvalumab批准前治疗的135例患者和在其批准后接受durvalumab治疗的100例患者的数据。在这两组中,超过70%是男性，平均年龄为66岁。大约85%是吸烟者，最常见的肿瘤组织学是腺癌。大多数患者的治疗剂量为60和66Gy(n=127[94%]vs.n=95[95%])。在接受Durvalumab治疗的患者中，57%,38%,5%的患者有1级,2级和3级肺炎,无4级或5级肺炎.与未接受Durvalumab治疗的患者(7周；范围：0.4-21周；P<0.001)相比，接受Durvalumab治疗的患者接受糖皮质激素治疗的肺炎持续时间更长(17周；范围：2-88周)。使用durvalumab治疗的患者（n=8;23％）的肺炎复发频率高于未使用durvalumab治疗的患者（n=2;7％）。在接受Durvalumab治疗的8例患者中，2有反复肺炎，1不能终止皮质类固醇。
结论：我们的数据表明，durvalumab延长了皮质类固醇治疗的持续时间，并增加了皮质类固醇逐渐减少模式的复杂性。这项研究可以帮助在常规实践和临床试验中管理由免疫检查点抑制剂和放化疗后使用的其他药物引起的肺炎。
方法：我们回顾性评估了2014年1月至2020年12月间接受放化疗的诊断为非小细胞肺癌患者的病历。
结果：分析了在durvalumab批准前治疗的135例患者和在其批准后接受durvalumab治疗的100例患者的数据。在这两组中,超过70%是男性，平均年龄为66岁。大约85%是吸烟者，最常见的肿瘤组织学是腺癌。大多数患者的治疗剂量为60和66Gy(n=127[94%]vs.n=95[95%])。在接受Durvalumab治疗的患者中，57%,38%,5%的患者有1级,2级和3级肺炎,无4级或5级肺炎.与未接受Durvalumab治疗的患者(7周；范围：0.4-21周；P<0.001)相比，接受Durvalumab治疗的患者接受糖皮质激素治疗的肺炎持续时间更长(17周；范围：2-88周)。使用durvalumab治疗的患者（n=8;23％）的肺炎复发频率高于未使用durvalumab治疗的患者（n=2;7％）。在接受Durvalumab治疗的8例患者中，2有反复肺炎，1不能终止皮质类固醇。
结论：我们的数据表明，durvalumab延长了皮质类固醇治疗的持续时间，并增加了皮质类固醇逐渐减少模式的复杂性。这项研究可以帮助在常规实践和临床试验中管理由免疫检查点抑制剂和放化疗后使用的其他药物引起的肺炎。
