Rising incidence of radiation pneumonitis after adjuvant durvalumab in NSCLC patients treated with concurrent chemoradiotherapy

Authors

  • Rutger H. Stoffers University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands https://orcid.org/0009-0000-1052-0999
  • Anne G.H. Niezink University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
  • Olga Chouvalova University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
  • Jan F. Ubbels University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
  • Marleen Woltman-van Iersel University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
  • T. Jeroen N. Hiltermann University of Groningen, Department of Lung Diseases and Tuberculosis, University Medical Center Groningen, Groningen, The Netherlands
  • Lucie B.M. Hijmering-Kappelle University of Groningen, Department of Lung Diseases and Tuberculosis, University Medical Center Groningen, Groningen, The Netherlands
  • Gea Douma Treant Hospital, Emmen, The Netherlands
  • Sander M. de Hosson Wilhelmina Hospital, Assen, The Netherlands
  • John W.G. van Putten Martini Hospital, Groningen, The Netherlands
  • Friso T. Zandberg Ommelander Hospital Group, Scheemda, The Netherlands
  • Lisanne V. van Dijk University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
  • Johannes A. Langendijk University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
  • Robin Wijsman University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands

DOI:

https://doi.org/10.2340/1651-226X.2025.42384

Keywords:

Non-small cell lung cancer, chemoradiotherapy, PD-L1 inhibitor, adverse events, Radiation pneumonitis

Abstract

Background and purpose: Adding adjuvant durvalumab to chemoradiotherapy (CRT) improves overall survival (OS) rates in locally advanced Non-Small-Cell Lung Cancer (NSCLC). However, recent data suggests that this new modality increases the incidence of radiation pneumonitis (RP). The aim of this study was to test the hypothesis that the incidence of RP after CRT and adjuvant durvalumab was higher than after CRT alone among patients with locally advanced NSCLC.

Materials and methods: The study population comprised all patients with NSCLC who completed CRT with curative intent between February 2013 and October 2020. From 2018 on, adjuvant durvalumab was administered in selected patients after completion of CRT. Patient and treatment data together with RP data (CTCAEv4.0, scored up to 9 months after CRT), were prospectively collected as part of our standard follow-up program.

Results: A total of 284 patients were included, of which 90 (30.5%) received adjuvant durvalumab. Incidence of grade ≥2 RP increased in patients receiving durvalumab compared to CRT only (17.8% vs. 8.8%; p < 0.05), especially between 6 to 9 months after completing CRT. Adjuvant durvalumab and mean lung dose (MLD) were associated with a higher incidence of grade ≥2 RP (odds ratio [OR]: 2.43 and 1.14, respectively; p < 0.05). Current smoking was found to be a protective factor (OR: 0.38; p < 0.05).

Interpretation: Adjuvant durvalumab significantly increased the incidence of grade ≥2 RP in this real-world cohort of NSCLC patients. Patients receiving adjuvant durvalumab remain prone to develop grade ≥2 RP longer after completing CRT compared to patients treated with CRT only.

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Author Biographies

Rutger H. Stoffers, University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands

MD

Anne G.H. Niezink, University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands

MD

Olga Chouvalova, University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands

MD

Jan F. Ubbels, University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands

MD

Marleen Woltman-van Iersel, University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands

MD

T. Jeroen N. Hiltermann, University of Groningen, Department of Lung Diseases and Tuberculosis, University Medical Center Groningen, Groningen, The Netherlands

MD, PhD

Lucie B.M. Hijmering-Kappelle, University of Groningen, Department of Lung Diseases and Tuberculosis, University Medical Center Groningen, Groningen, The Netherlands

MD, PhD

Gea Douma, Treant Hospital, Emmen, The Netherlands

MD

Sander M. de Hosson, Wilhelmina Hospital, Assen, The Netherlands

MD

John W.G. van Putten, Martini Hospital, Groningen, The Netherlands

MD, PhD

Friso T. Zandberg, Ommelander Hospital Group, Scheemda, The Netherlands

MD

Lisanne V. van Dijk, University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands

MD, PhD

Johannes A. Langendijk, University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands

MD, PhD

Robin Wijsman, University of Groningen, Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands

MD, PhD

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Published

2025-02-13

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Stoffers, R. H., Niezink, A. G., Chouvalova, O., Ubbels, J. F., Woltman-van Iersel, M., Hiltermann, T. J. N., … Wijsman, R. (2025). Rising incidence of radiation pneumonitis after adjuvant durvalumab in NSCLC patients treated with concurrent chemoradiotherapy. Acta Oncologica, 64, 267–275. https://doi.org/10.2340/1651-226X.2025.42384

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Vol. 64 (2025): Acta Oncologica

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Copyright (c) 2025 Rutger H. Stoffers, Anne G.H. Niezink, Olga Chouvalova, Jan F. Ubbels, Marleen Woltman-van Iersel, T. Jeroen N. Hiltermann, Lucie B.M. Hijmering-Kappelle, Gea Douma, Sander M. de Hosson, John W.G. van Putten, Friso T. Zandberg, Lisanne V. van Dijk, Johannes A. Langendijk, Robin Wijsman

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