Do you offer consolidation durvalumab in a patient who had pneumonitis requiring steroids following chemoradiation for LS-SCLC?

In the ADRIATIC trial, pneumonitis or radiation pneumonitis occurred in 38.2% of durvalumab-treated patients, and 8.8% discontinued treatment due to pneumonitis (Cheng et al., PMID 39268857). While there is emerging interest in immune checkpoint inhibitor rechallenge after successful management of immune-related adverse events (as evidenced by ongoing trials like CCTG IND.238A), the decision to offer durvalumab in this scenario requires careful individualized assessment, including key considerations of the severity and duration of the prior pneumonitis, time to resolution, steroid requirements and taper course, baseline pulmonary function, extent of radiation-induced lung injury, and the patient's overall risk-benefit profile given their ca...

The ADRIATIC trial with the addition of consolidative durvalumab for 24 months showed significant improvement in OS and PFS in LS-SCLC. The median survival was improved from 33.4 months with placebo to 55.9 months with durva (HR 0.73, p=0.01), and PFS was improved from 9.2 months w/o durva to 16.6 months with durvalumab (HR 0.76, p=0.02). This improvement was seen after decades of efforts to improve outcomes in this aggressive disease.

Keeping that in mind, my approach is to treat all eligible patients with 2 years of consolidative durvalumab.

In patients with pneumonitis following chemo-RT, I will delay or hold their durvalumab (if already initiated) until their pneumonitis symptoms resolve completely with tapering of the steroid to a dose o...