Radiotherapy Patterns of Care for Locally-advanced Non-small Cell Lung Cancer in the Pre- and Post-durvalumab Era: A Region-wide Survey in a Japanese Prefecture

• Published in: Journal of radiation research Vol. 63; no. 2; pp. 264 - 271
• Main Authors: Kubo, Nobuteru, Kobayashi, Daijiro, Iwanaga, Mototaro, Matsuura, Masana, Higuchi, Keiko, Eishima, Jun, Muramatsu, Hiroyuki, Okano, Naoko, Shioya, Mariko, Onishi, Masahiro, Aoki, Tetsuya, Oike, Takahiro, Ohno, Tatsuya
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.03.2022
• Subjects: Antibodies, Monoclonal - therapeutic use; Carcinoma, Non-Small-Cell Lung - pathology; Care and treatment; Chemoradiotherapy - adverse effects; Development and progression; Humans; Japan - epidemiology; Lung cancer, Non-small cell; Lung Neoplasms - pathology; National health insurance; Oncology/Medicine; Pemetrexed; Radiotherapy; Japan; patterns of care; concurrent chemoradiotherapy (CCRT); durvalumab; non-small cell lung carcinoma (NSCLC)
• ISSN: 0449-3060; 1349-9157
• DOI: 10.1093/jrr/rrab116

Abstract The promising results of the PACIFIC study led to the approval of consolidation durvalumab for coverage by the National Health Insurance (NHI) in 2018 for patients with locally-advanced unresectable non-small cell lung carcinoma (NSCLC) treated with definitive concurrent chemoradiotherapy (CCRT). However, the effect of NHI coverage on the patterns of care for this population remains unclear. Here, we conducted a questionnaire-based survey to determine the patterns of care for patients with stage II–III NSCLC treated with definitive radiotherapy in 2017 (pre-durvalumab era) or in 2019 (post-durvalumab era). Data were obtained from 11 radiotherapy facilities in Gunma prefecture, which has a population of 1.94 million. We identified 80 and 83 patients with stage II–III NSCLC who received definitive radiotherapy in Gunma in 2017 and 2019, respectively. At a given facility, CCRT was the treatment of choice in a significantly greater proportion of patients in 2019 than in 2017 (66% ± 20% vs 51% ± 29%, P = 0.041). Intensity-modulated radiotherapy (IMRT) was more frequent in 2019 than in 2017 (24% vs 1.2%). Carboplatin plus paclitaxel was used for CCRT at higher rate in 2019 than in 2017 (73% vs 44%). Consolidation durvalumab was performed in 73% (40/55) of CCRT-treated patients in 2019, and the treatment was performed for the planned 12 months in 45% (18/40) of patients. These data indicate that NHI coverage of durvalumab might be a possible reason for choosing CCRT in patients with stage II–III NSCLC in the real-world setting.