Impact of Durvalumab on the Duration and Complexity of Corticosteroid Therapy for Pneumonitis after Chemoradiotherapy

Introduction It is unclear how the duration and tapering pattern of corticosteroid therapy for pneumonitis changed after the introduction of durvalumab consolidation therapy. Methods We retrospectively evaluated the medical records of patients diagnosed with non-small cell lung cancer who received chemoradiotherapy between January 2014 and December 2020. Results Data for 135 patients treated before durvalumab approval and 100 patients treated with durvalumab after its approval were analyzed. In both groups, more than 70% were male, with a median age of 66 y. Approximately 85% were smokers, and the most common tumor histology was adenocarcinoma. Most patients were treated with doses of 60 and 66 Gy (n=127 [94%] vs. n=95 [95%]). Among the patients treated with durvalumab, 57%, 38%, and 5% had grade 1, grade 2, and grade 3 pneumonitis; none had grade 4 or 5 pneumonitis. Patients treated with durvalumab exhibited a longer duration of corticosteroid therapy for pneumonitis (17 wk; range: 2–88 wk) than patients not treated with durvalumab (7 wk; range: 0.4–21 wk; p<0.001). Pneumonitis relapse was more frequent in patients treated with durvalumab (n=8; 23%) than in patients not treated with durvalumab (n=2; 7%). Among the eight patients treated with durvalumab, two had recurrent pneumonitis, one could not terminate corticosteroids. Conclusions Our data show that durvalumab prolongs the duration of corticosteroid therapy and increases the complexity of corticosteroid tapering patterns. This study can help manage pneumonitis caused by immune checkpoint inhibitors and other drugs used after chemoradiotherapy in routine practice and clinical trials. Micro abstruct • This study evaluated how durvalumab changed the duration and pattern of corticosteroid therapy by comparing 135 chemoradiation-only patients with 123 patients receiving durvalumab.• Durvalumab was associated with a prolonged (17wk vs. 7wk, p<0.001) and complicated course of corticosteroid tapering.• More pneumonitis relapses occurred in patients on durvalumab than in those without (23% vs. 7%).