Durvalumab as a Consolidation Therapy for Locally Advanced NSCLC

Julie Brahmer, MD:When I see a patient in clinic, I consider various different factors when we’re sitting down and talking about durvalumab in the consolidative setting. One, I think it’s very important from the get-go to mention the fact that patients will be offered consolidation therapy so they are not surprised after they think they completed treatment with chemotherapy and radiation that, then, they will have another year of treatment thereafter.

When I’m talking with a patient, we certainly talk about the risks. If they already have autoimmune diseases, we’ll sit down and talk about the risk of potential worsening of their known autoimmune disease. Someone who comes in with rheumatoid arthritis to begin with, we may be less likely to give durvalumab, compared with someone who has no history of autoimmune diseases.

When you have a patient with stage 3 disease, after they receive concurrent chemotherapy and radiation, I would highly recommend considerations of durvalumab as consolidation therapy. This is the first treatment ever that showed a survival advantage in this group of patients, and to afford these patients a chance for cure down the road, it’s very important to discuss the pros and cons of receiving this with our patients.

Transcript edited for clarity.

Case: A 59-year-old Woman With Locally Advanced NSCLC

• A 59-year-old woman presents after referral from primary care for persistent cough and bloody sputum. She denies shortness of breath, says cough began last fall and she attributes it and the sputum to allergies.
• History:
  • 10-year smoking history, ages 15 to 25
  • Postmenopausal, BMI = 26 kg/m²
  • Basal cell carcinoma on chest and face, had 3 lesions removed 2 years ago
• Evaluation and follow up testing reveal stage IIIB NSCLC:
  • Radiograph shows 2 lesions in left lung (3.1 cm and 5.5 cm)
  • Fiber optic bronchoscopy identifies NSCLC
  • Endobronchial ultrasound reveals ipsilateral mediastinal lymph node involvement
  • WHO performance status 1
  • Histology: nonsquamous
  • Biomarkers
    • EGFRnegative,BRAFnegative,ALK/ROS1negative
    • PD-L1 status: >25%
• Laboratory findings:
  • WBC, renal function, hepatic function within normal ranges
• After multidisciplinary evaluation, the patient was determined not to be a surgical candidate
• She completed a weekly carboplatin/paclitaxel doublet therapy with concomitant radiotherapy (60 Gy)
  • Achieved partial response without progression 3 weeks later
  • Began treatment with durvalumab