PACIFIC-R: First real-world study of patients with unresectable, stage III NSCLC treated with durvalumab after chemoradiotherapy

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Treatment Characteristics and Real-World Progression-Free Survival in Patients With Unresectable Stage III NSCLC Who Received Durvalumab After Chemoradiotherapy: Findings From the PACIFIC-R Study.

IntroductionThe phase 3 PACIFIC trial established consolidation therapy with durvalumab as standard of care for patients with unresectable, stage III NSCLC and no disease progression after definitive chemoradiotherapy (CRT). The observational PACIFIC-R study assesses the real-world effectiveness of durvalumab in patients from an early access program. Here, we report treatment characteristics and a preplanned analysis of real-world progression-free survival (rwPFS).MethodsPACIFIC-R (NCT03798535) is an ongoing, international, retrospective study of patients who started durvalumab (intravenously; 10 mg/kg every 2 wk) within an early access program between September 2017 and December 2018. The primary end points are investigator-assessed rwPFS and overall survival (analyzed by Kaplan-Meier method).ResultsAs of November 30, 2020, the full analysis set comprised 1399 patients from 11 countries (median follow-up duration, 23.5 mo). Patients received durvalumab for a median of 11.0 months. Median rwPFS was 21.7 months (95% confidence interval: 19.1-24.5). RwPFS was numerically longer among patients who received concurrent versus sequential CRT (median, 23.7 versus 19.3 mo) and among patients with programmed cell death-ligand 1 expression greater than or equal to 1% versus less than 1% (22.4 versus 15.6 mo). Overall, 16.5% of the patients had adverse events leading to treatment discontinuation; 9.5% of all patients discontinued because of pneumonitis or interstitial lung disease.ConclusionsConsolidation durvalumab after definitive CRT was well tolerated and effective in this large, real-world cohort study of patients with unresectable, stage III NSCLC. As expected, rwPFS was longer among patients who received concurrent versus sequential CRT and patients with higher programmed cell death-ligand 1 expression. Nevertheless, favorable rwPFS outcomes were observed regardless of these factors

La radiothérapie de conformation (une nouvelle thérapeutique à visée curative dans la prise en charge du carcinome hépatocellulaire ?)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Radiothérapie de conformation à haute dose (74 Gy) des carcinomes broncho-pulmonaires non à petites cellules (Résultats matures d'une série rétrospective de 50 patients traités par chimio-radiothérapie exclusive.)

LYON1-BU Santé (693882101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Radiothérapie stéréotaxique des cancers broncho-pulmonaires non à petites cellules : d’un concept à une réalité clinique. Actualités en 2011

Girard, NMornex, FFranceCancer Radiother. 2011 Oct;15(6-7):522-6. Epub 2011 Sep 1.National audienceOnly 60% of patients with early-stage non-small cell lung cancer (NSCLC), a priori bearing a favorable prognosis, undergo radical resection because of the very frequent co-morbidities occurring in smokers, precluding surgery to be safely performed. Stereotactic radiotherapy consists of the use of multiple radiation microbeams, allowing high doses of radiation to be delivered to the tumour (ranging from 7.5 to 20 Gy per fraction) in a small number of fractions (one to eight on average). Several studies with long-term follow-up are now available, showing the effectiveness of stereotactic radiotherapy to control stage I/II non-small cell lung cancer in medically inoperable patients. Local control rates are consistently reported to be above 95% with a median survival of 34 to 45 months. Because of these excellent results, stereotactic radiation therapy is now being evaluated in operable patients in several randomized trials with a surgical arm. Ultimately, the efficacy of stereotactic radiotherapy in early-stage tumours leads to hypothesize that it may represent an opportunity for locally-advanced tumors. The specific toxicities of stereotactic radiotherapy mostly correspond to radiation-induced chest wall side effects, especially for peripheral tumours. The use of adapted fractionation schemes has made feasible the use of stereotactic radiotherapy to treat proximal tumours. Overall, from a technical concept to the availability of specific treatment devices and the publication of clinical results, stereotactic radiotherapy represents a model of implementation in thoracic oncology.Seuls 60% des cancers broncho-pulmonaires non à petites cellules de stade précoce, a priori de pronostic favorable, font l’objet d’une résection chirurgicale, du fait des "co-morbidités" très fréquentes chez les patients fumeurs, qui limitent les possibilités opératoires. L’irradiation stéréotaxique correspond à l’utilisation de microfaisceaux d’irradiation multiples, permettant la délivrance de doses élevées d’irradiation (le plus souvent comprises entre 7,5et 20Gy par fraction) en un faible nombre de séances (une à huit en moyenne). Plusieurs études ont démontré son efficacité pour la prise en charge des cancers broncho-pulmonaires de stade I ou II chez les patients médicalement inopérables. Les taux de contrôle local sont supérieurs à 95% et la durée médiane de survie de 34à 45mois. Du fait de ces excellents résultats, la radiothérapie stéréotaxique est actuellement évaluée pour la prise en charge de tumeurs de stade précoce chez des patients opérables, au travers de plusieurs essais randomisés la comparant à la chirurgie. L’efficacité de la radiothérapie stéréotaxique pour les tumeurs de stade précoce conduit à poser aussi la question de son intégration dans le traitement des tumeurs plus évoluées. La toxicité spécifique de la radiothérapie stéréotaxique comprend des atteintes de la paroi thoracique, en particulier pour les tumeurs très périphériques. L’utilisation d’un fractionnement adapté permet de traiter des tumeurs proximales. Au total, d’un concept technique à la mise à disposition de systèmes de traitement spécifiques et à la publication de résultats cliniques, la radiothérapie stéréotaxique représente un modèle d’implémentation en oncologie thoracique

Radiothérapie du carcinome hépatocellulaire (mobilité organique et impact dosimétrique du blocage respiratoire)

The irradiation of hepatocellular carcinoma (HCC) is a challenge due to the low tolerance of the liver to the x-rays, the existence of many organs at risk (OAR) (liver, kidneys, spinal cord,stomach, and duodenum) and the presence of the underlying cirrhosis. Thanks to the conformal radiotherapy we can deliver a high curative dose to a part of the liver. However, the breath movements require the increasing of the safety margin around the liver and the OARs. The feasibility of the respiratory gating has been proved especially in the treatment of lung, breast and liver cancer : it reduces the irradiation to the healthy tissue and allows a dose-escalation to the tumor. To improve the radiotherapy treatment we propose to evaluate the benefice of the breath-hold technique in the treatment of liver cancer. We analysed the mobility of the liver cancer during the respiration to better optimize the defination of the target volumes and mostly the internal margins (IM), and also the amplitude of movements of the OARs involved in the tolerance of the HCC irradiation. We used different dosimetric analysis parameters to evaluate the benefice of respiratory gating, comparing the dosimetric plans in exhale and inhale with with the ones in free respiration. This will allow us to quantify the benefice obtained by the breath-hold technique and to determine the optimal respiratory phase of the treatment. Being involved in an extracranial stereotactic project at Lyon Sud Hospital, we realised a study about the non coplanar beam optimization to better preserve the non involved liverLYON1-BU.Sciences (692662101) / SudocSudocFranceF

Is concurrent twice-daily thoracic radiotherapy with chemotherapy the reference treatment for small cell lung cancer?

SCOPUS: no.jinfo:eu-repo/semantics/publishe