Real-World Incidence Of Grade Iii/Iv Side Effects, Emergency Room Visits, And Hospital Admissions After Treatment With Adjuvant Durvalumab In Locally Advanced Non-Small Cell Lung Cancer.

e19276 Background: Durvalumab is a selective human IgG1 monoclonal antibody that blocks PD-L1 binding to PD-1 and CD80, allowing T cells to recognize and kill tumor cells. Durvalumab is FDA approved for adjuvant treatment of locally advanced unresectable NSCLC after definitive chemoradiation based on data presented in the PACIFIC trial with benefit in PFS and overall survival. In the PACIFIC trial, discontinuation of the durvalumab because of adverse events occurred in 15.4% of the patients. The most frequent adverse events leading to its discontinuation were pneumonitis (4.8%), radiation pneumonitis (1.3%), and pneumonia (1.1%). The aim of our study is to review real world single institution experience of durvalumab in locally advanced NSCLC. Methods: 23 patient charts with locally advanced NSCLC who had durvalumab ordered for adjuvant treatment were reviewed. 4 patients were excluded given failure to start durvalumab or lack of complete records with treatment at outside institutions. Results: 19 patients were included in the final analysis. 18/19 patients received definitive chemoRT and 1 patient received definitive RT alone given co-morbidities. 8 patients finished durvalumab and 4 are currently on treatment. 8/19 patients (42.1%) had Grade III/IV side effects reported. 7/19 (36.8%) patients had durvalumab discontinued. In 6 patients (31.5%), durvalumab was discontinued due to Grade III/IV toxicity (all with pneumonitis) while 1 patient had sepsis with disease progression. 2 patient had died with one patient death related to pneumonitis/pneumonia along with underlying co-morbidities and the second patient with disease progression. 4 patients (21%) had 7 ER visits and 5 patients (26%) were admitted to the hospital for various reasons 7 times. 2 patients required higher level of care in the step down unit. Treatment was delayed only twice in all 19 patients because of a clinical reason. Conclusions: Durvalumab is an exciting new development in the treatment of locally advanced NSCLC. Our review revealed higher than previously reported incidence of pulmonary toxicity as well as higher discontinuation rate. Other than pulmonary toxicity, durvalumab is very well tolerated with low incidence of ER visits, hospital admissions and treatment delays. Clinicians should monitor patients very closely for pulmonary toxicity during durvalumab treatment. Regular pulmonary function testing may be a reasonable approach to monitor the patients on durvalumab.