预测在不可切除的局部晚期非小细胞肺癌行用durvalumab维持治疗期间发生肺损伤的因素。
Predictors of lung injury during durvalumab maintenance therapy following concurrent chemoradiotherapy in unresectable locally advanced non-small cell lung carcinoma.
发表日期：2023 Aug 02
作者：
Nobuyuki Hirama, Masaki Yamamoto, Satoshi Nagaoka, Wataru Segawa, Chihiro Sugimoto, Hirokazu Nagayama, Shuntaro Hiro, Yukihito Kajita, Chihiro Maeda, Sousuke Kubo, Kenichi Seki, Yoshinori Nagahara, Shuhei Teranishi, Ken Tashiro, Yu Hara, Nobuaki Kobayashi, Shigenobu Watanabe, Makoto Kudo, Takeshi Kaneko
来源：
MEDICINE & SCIENCE IN SPORTS & EXERCISE
摘要：
根据PACIFIC试验的结果，在无法手术切除的局部晚期非小细胞肺癌（NSCLC）患者中，采用durvalumab维持治疗已成为同时化疗放疗后的标准治疗。然而，durvalumab引起的不良事件，尤其是肺损伤，包括免疫相关不良事件和放射性肺炎，引起了关注。本研究回顾性调查了接受PACIFIC方案的患者肺部损伤相关因素。纳入了于2018年7月至2022年3月在横滨市立大学医疗中心接受同时化疗放疗后durvalumab维持治疗的无法手术切除的局部晚期NSCLC患者。评估了临床资料、正常肺部20或5 Gy或更多的体积（V20或V5）、计划靶体积（PTV）以及肺气肿肺组织中20或5 Gy或更多的相对肺实质体积（RLPV20或5; V20或V5/低衰减体积的百分比）。
单变量分析显示，肺损伤组中的PS、V20、V5、PTV、RLPV20和RLPV5显著升高。此外，在包括PS、PTV、V20和RLPV20的多变量分析中，RLPV20是肺损伤组中最重要的因素。
RLPV20和RLPV5在评估肺部炎症方面是有用的。在无法手术切除的局部晚期NSCLC患者中，RLPV20可能被认为是同时化疗放疗后durvalumab维持治疗的最可靠的风险因素。© 2023 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.
Based on the results of the PACIFIC trial, maintenance with durvalumab has emerged as the standard treatment following concurrent chemoradiotherapy in patients with unresectable locally advanced non-small cell lung carcinoma (NSCLC). However, adverse events attributed to durvalumab, especially lung injuries, including immune-related adverse events, and radiation pneumonitis, are concerning. This study retrospectively investigated the factors related to lung injury in patients receiving the PACIFIC regimen.Patients with unresectable locally advanced NSCLC who received durvalumab maintenance therapy following concurrent chemoradiotherapy at Yokohama City University Medical Centre between July 2018 and March 2022 were included. Clinical data, volume of normal lung receiving 20 or 5 Gy or more (V20 or V5), planning target volume (PTV), and relative lung parenchyma volume in emphysematous lung receiving 20 or 5 Gy or more (RLPV20 or 5; V20 or V5/100-percentage of low-attenuation volume) were evaluated.Performance status (PS), V20, V5, PTV, RLPV20, and RLPV5 were significantly higher in the lung injury group in the univariate analysis. Furthermore, RLPV20 was the most significant factor in the lung injury group in the multivariate analysis comprising PS, PTV, V20, and RLPV20.RLPV20 and RLPV5 are useful in estimating lung inflammation. RLPV20 could be considered the most reliable risk factor for maintenance therapy with durvalumab following concurrent chemoradiotherapy in patients with unresectable locally advanced NSCLC.© 2023 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.