Lung Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_23_3541 - Patterns of Pneumonitis after Chemoradiation Therapy and Immunotherapy for StageIII Non-Small Cell Lung Cancer

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Patterns of Pneumonitis after Chemoradiation Therapy and Immunotherapy for StageIII Non-Small Cell Lung Cancer
K. Harada1, K. Takahashi2, K. Inaba2, N. Murakami2, H. Igaki2, Y. Ito3, Y. Nakayama4, and J. Itami2; 1Tokai University, Kanagawa, Japan, 2National Cancer Center Hospital, Tokyo, Japan, 3Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan, 4Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama 241-0815, Japan

Purpose/Objective(s): Interest has been increasing in the use of immunotherapy (IT) to treat non-small cell lung cancer (NSCLC). However, adverse effects after radiation therapy and IT are not well known. This study analyzed the pattern of pneumonitis after chemoradiation therapy (CRT) and IT for relapsed stageIII NSCLC.

Materials/Methods: There were 100 patients with stageIII NSCLC treated with CRT between 2015 and 2017 at our institution. Of those, 16 patients were relapsed and underwent IT (nivolmab, 10; pembrolizmab, 6) after CRT. Pneumonitis was retrospectively scored with CTCAEv4.0. Systemic corticosteroid therapy was performed to treat pneumonitis.

Results: The median age was 69 years (range, 52-78 years). The median dose administered was 60 Gy (range, 60-70 Gy). The median duration after CRT to IT was 7.8 months (range, 1.7-12.8 months). The median number of IT administration was 7 (1-26). There were 10 patients who had pneumonitis before (G1, 3; G2, 1; G3, 1) and after (G2, 1; G3, 3; G4, 1) IT. The median interval between the end of CRT and the occurrence of pneumonitis was 10 months (range, 4-12 months). Five patients who had pneumonitis before IT were all radiation-induced, and there was no pneumonitis after IT. Other 5 patients were difficult to distinguish whether the pneumonitis was radiation-induced or IT induced. Of those, one patient had a pneumonitis outside the radiation field, and assumed to be caused by IT. Other 4 patients had a pneumonitis within the radiation field, and 2 were suspected radiation recall pneumonitis, and the other 2 were extended outside the radiation field after decreasing the amount of corticosteroid. Pathological diagnosis was not impossible to determine radiation-induced or IT induced pneumonitis for those cases.

Conclusion: The incidence of IT induced pneumonitis was not so much higher than that of radiation induced pneumonitis. However, the timing of radiation-induced pneumonitis and IT induced pneumonitis after CRT and IT is very close. It is important to be cautious about patient respiratory symptoms. A history of radiation-induced pneumonitis did not affect the occurrence of pneumonitis after the administration of IT.

Author Disclosure: K. Harada: None. K. Takahashi: None. K. Inaba: None. N. Murakami: None. Y. Ito: None. J. Itami: Travel Expenses; Elekta. Councillor; Japanese Society of Clinical Oncology. Counsillor; JASTRO.

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