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Peer-reviewedCC BYBMC Cancer

Durvalumab completion and re-administration after grade 2 radiation pneumonitis following concurrent chemoradiotherapy for unresectable stage III NSCLC: a single-center real-world study

  • Shuri Aoki1
  • Ryo Ariyasu2
  • Tatsuya Kamima1
  • Yosuke Sato1
  • Kenji Tokumasu1
  • Wataru Anno1
  • Yasuhiro Ogura1
  • Masahiro Kaneko1
  • Mingyon Mun3
  • Hironori Ninomiya4
  • Makoto Nishio2
  • Yasuo Yoshioka1
4 affiliations
  1. 1Department of Radiation Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research
  2. 2Department of Thoracic Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research
  3. 3Department of Thoracic Surgical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research
  4. 4Department of Pathology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research
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Abstract

Background and purpose This study evaluated the incidence and clinical impact of radiation pneumonitis (RP) in patients with unresectable stage III non-small cell lung cancer (NSCLC) treated with durvalumab following concurrent chemoradiotherapy (CCRT), with a particular focus on durvalumab interruption, re-administration, and overall survival (OS). Materials and methods This retrospective study included patients treated at our institution between April 2018 and June 2024. Durvalumab was administered for up to one year or until discontinuation due to adverse events or disease progression. RP was graded according to CTCAE version 5.0. Associations between grade ≥ 2 RP and clinical or treatment-related factors were assessed using univariate and multivariate analyses. Survival outcomes were analyzed using the Kaplan–Meier method and Cox proportional hazards models. Results Among 101 patients, 48 (47.5%) developed grade ≥ 2 RP (grade 2: 41.6%; grade 3: 4.0%; grade 4: 2.0%). Lung V20 > 30% was independently associated with grade ≥ 2 RP. Durvalumab interruption occurred in a subset of patients with grade 2 RP; among these patients, 25 (59.5%) were able to undergo durvalumab re-administration, with RP recurrence observed in only one patient after re-administration. The 2-year and 3-year OS rates were 75.1% and 60.9%, respectively. Completion of durvalumab was the strongest independent predictor of OS (hazard ratio 0.14; P = 0.00007), whereas grade ≥ 2 RP itself was not significantly associated with OS. Conclusions In this real-world cohort, completion of durvalumab consolidation after CCRT was strongly associated with improved OS in patients with stage III NSCLC. Although grade ≥ 2 RP was a frequent complication, temporary interruption and re-administration were feasible in selected patients. However, these findings should be interpreted cautiously because of the retrospective design and potential residual confounding.

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Cite

BibTeXRIS
BibTeX
@article{aoki2026durvalumab,
  title = {{Durvalumab completion and re-administration after grade 2 radiation pneumonitis following concurrent chemoradiotherapy for unresectable stage III NSCLC: a single-center real-world study}},
  author = {Shuri Aoki and Ryo Ariyasu and Tatsuya Kamima and Yosuke Sato and Kenji Tokumasu and Wataru Anno and Yasuhiro Ogura and Masahiro Kaneko and Mingyon Mun and Hironori Ninomiya and Makoto Nishio and Yasuo Yoshioka},
  journal = {BMC Cancer},
  year = {2026},
  month = jul,
  doi = {10.1186/s12885-026-16445-w},
  url = {https://doi.org/10.1186/s12885-026-16445-w},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Durvalumab completion and re-administration after grade 2 radiation pneumonitis following concurrent chemoradiotherapy for unresectable stage III NSCLC: a single-center real-world study
AU  - Shuri Aoki
AU  - Ryo Ariyasu
AU  - Tatsuya Kamima
AU  - Yosuke Sato
AU  - Kenji Tokumasu
AU  - Wataru Anno
AU  - Yasuhiro Ogura
AU  - Masahiro Kaneko
AU  - Mingyon Mun
AU  - Hironori Ninomiya
AU  - Makoto Nishio
AU  - Yasuo Yoshioka
PY  - 2026
DA  - 2026/07/01
JO  - BMC Cancer
DO  - 10.1186/s12885-026-16445-w
UR  - https://doi.org/10.1186/s12885-026-16445-w
AB  - Background and purpose This study evaluated the incidence and clinical impact of radiation pneumonitis (RP) in patients with unresectable stage III non-small cell lung cancer (NSCLC) treated with durvalumab following concurrent chemoradiotherapy (CCRT), with a particular focus on durvalumab interruption, re-administration, and overall survival (OS). Materials and methods This retrospective study included patients treated at our institution between April 2018 and June 2024. Durvalumab was administered for up to one year or until discontinuation due to adverse events or disease progression. RP was graded according to CTCAE version 5.0. Associations between grade ≥ 2 RP and clinical or treatment-related factors were assessed using univariate and multivariate analyses. Survival outcomes were analyzed using the Kaplan–Meier method and Cox proportional hazards models. Results Among 101 patients, 48 (47.5%) developed grade ≥ 2 RP (grade 2: 41.6%; grade 3: 4.0%; grade 4: 2.0%). Lung V20 > 30% was independently associated with grade ≥ 2 RP. Durvalumab interruption occurred in a subset of patients with grade 2 RP; among these patients, 25 (59.5%) were able to undergo durvalumab re-administration, with RP recurrence observed in only one patient after re-administration. The 2-year and 3-year OS rates were 75.1% and 60.9%, respectively. Completion of durvalumab was the strongest independent predictor of OS (hazard ratio 0.14; P = 0.00007), whereas grade ≥ 2 RP itself was not significantly associated with OS. Conclusions In this real-world cohort, completion of durvalumab consolidation after CCRT was strongly associated with improved OS in patients with stage III NSCLC. Although grade ≥ 2 RP was a frequent complication, temporary interruption and re-administration were feasible in selected patients. However, these findings should be interpreted cautiously because of the retrospective design and potential residual confounding.
SN  - 1471-2407
ER  -