Clinical outcomes by infusion timing of immune checkpoint inhibitors in patients with locally advanced NSCLC

Introduction Previous studies reported an association between immune checkpoint inhibitor (ICI) infusion timing and the treatment effect in metastatic NSCLC. The present study assessed the association between durvalumab infusion timing and survival outcomes in patients with locally advanced NSCLC. Methods Patients receiving durvalumab following chemoradiotherapy for locally advanced NSCLC at a single institution were retrospectively analyzed, and the association of the proportion of durvalumab infusions ≥20% vs. <20% after 15:00h with progression-free survival (PFS) and overall survival (OS) was assessed. Results Eighty-two patients were included, with a median age of 69 years (interquartile range [IQR]: 62–74 years); of these, 67 (82%) were male, and 78 (95%) had a history of smoking. The median number of durvalumab infusions per patient was 16 (IQR: 8–24). Patients with at least 20% of their durvalumab infusions after 15:00h (n=12/82, 15%) had a significantly shorter PFS than those who did not (median: 7.4 months vs not available [NA]; hazard ratio [HR]: 2.43; 95% confidence interval [CI]: 1.11–5.34, P=0.027) while OS was shorter among former than the latter group (median: 22.4 vs. NA; HR: 1.80; 95% CI: 0.73–4.42, P=0.20). Additionally, both backward stepwise multivariable analysis and propensity score-matching analysis revealed that receiving at least 20% of durvalumab infusions after 15:00h was significantly associated with worse PFS (HR: 2.54; 95% CI: 1.03–5.67, P=0.047; and HR: 4.64; 95% CI: 1.95–11.04, P < 0.001, respectively). Conclusions Time of day of durvalumab infusions may impact survival outcomes in patients with locally advanced NSCLC.