Impact of radiation on host immune system in patients treated with chemoradiotherapy and durvalumab consolidation for unresectable locally advanced non-small cell lung cancer

Corentin Pasquier; Léonor Chaltiel; Carole Massabeau; Audrey Rabeau; Louisiane Lebas; Amélie Lusque; Jean-Sébastien Texier; Elizabeth Cohen-Jonathan Moyal; Julien Mazières; Jonathan Khalifa

doi:10.3389/fonc.2023.1186479

Impact of radiation on host immune system in patients treated with chemoradiotherapy and durvalumab consolidation for unresectable locally advanced non-small cell lung cancer

Front Oncol. 2023 Jun 16:13:1186479. doi: 10.3389/fonc.2023.1186479. eCollection 2023.

Authors

Affiliations

¹ Department of Radiation Oncology, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France.
² Department of Biostatistics, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France.
³ Department of Thoracic Oncology, Centre Hospitalier Universitaire de Toulouse, Hôpital Larrey, Toulouse, France.
⁴ Department of Pulmonology, Centre Hospitalier Intercommunal des Vallées de l'Ariège (CHIVA), Saint-Jean-de-Verges, France.
⁵ Department of Nuclear Medicine, Institut Claudius Regaud/Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France.
⁶ Université de Toulouse III Paul Sabatier, Toulouse, France.
⁷ Institut National de la Santé et de la Recherche Médicale U1037, Centre de Recherche contre le Cancer de Toulouse, Toulouse, France.

Abstract

Background: The optimal modalities of radiotherapy when combining concurrent chemoradiation (CCRT) and immunotherapy (IO) for locally advanced non-small cell lung cancer (LA-NSCLC) remain to be determined. The aim of this study was to investigate the impact of radiation on different immune structures and immune cells in patients treated with CCRT followed by durvalumab.

Material and methods: Clinicopathologic data, pre- and post-treatment blood counts, and dosimetric data were collected in patients treated with CCRT and durvalumab consolidation for LA-NSCLC. Patients were divided into two groups according to the inclusion (NILN-R+) or not (NILN-R-) of at least one non-involved tumor-draining lymph node (NITDLN) in the clinical target volume (CTV). Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan-Meier method.

Results: Fifty patients were included with a median follow-up of 23.2 months (95% CI 18.3-35.2). Two-year PFS and 2-year OS were 52.2% (95% CI 35.8-66.3) and 66.2% (95% CI 46.5-80.1), respectively. In univariable analysis, NILN-R+ (hazard ratio (HR) 2.60, p = 0.028), estimated dose of radiation to immune cells (EDRIC) >6.3 Gy (HR 3.19, p = 0.049), and lymphopenia ≤ 500/mm³ at IO initiation (HR 2.69, p = 0.021) were correlated with poorer PFS; lymphopenia ≤ 500/mm³ was also associated with poorer OS (HR 3.46, p = 0.024). In multivariable analysis, NILN-R+ was the strongest factor associated with PFS (HR 3.15, p = 0.017).

Conclusion: The inclusion of at least one NITDLN station within the CTV was an independent factor for poorer PFS in the context of CCRT and durvalumab for LA-NSCLC. The optimal sparing of immune structures might help in achieving better synergy between radiotherapy and immunotherapy in this indication.

Keywords: EDRIC; elective node irradiation; immunotherapy; lymphopenia; non-small cell lung cancer (NSCLC); radiotherapy; tumor-draining lymph nodes (TDLN).