Durvalumab after concurrent chemoradiotherapy in a patient with chemotherapy-resistant unresectable stage III non-small cell lung cancer: a case report

Lung Cancer
22/07/2020

Ann Palliat Med. 2020 Jul 20:apm-20-1118. doi: 10.21037/apm-20-1118. Online ahead of print.

ABSTRACT

Durvalumab as consolidative immunotherapy following concurrent chemoradiotherapy (cCRT) is the standard treatment for patients with unresectable stage III non-small cell lung cancer (NSCLC). Here, we describe a case of unresectable stage III NSCLC who was chemotherapy resistant, benefit from cCRT and durvalumab. Contrast-enhanced computed tomography (CT) evaluation of the patient detected a mass in the left upper mediastinum. The biopsy specimen showed evidence of poorly differentiated pulmonary


carcinoma. Brain magnetic resonance imaging (MRI) and bone scan found no evidence of distant metastasis. The clinical stage was defined as T4N2M0 IIIB. The patient underwent one cycle of induction chemotherapy with cisplatin and etoposide. Positron-emission tomography/computed tomography (PET-CT) after induction chemotherapy showed the tumor increased in size. The patient received volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB) and the radiation dose was 60.2 Gy/2.15 Gy/28 F. Concurrent chemotherapy was delivered and the regimen was weekly paclitaxel liposome combined with nedaplatin. Durvalumab was given one day after the final fraction of radiotherapy. CT evaluation performed one month and three months after treatment found partial response (PR). Grade 1 pneumonitis was reported as a toxicity. The use of durvalumab following cCRT was feasible and efficient in this patient who was resistant to chemotherapy and that its early use was safe.