Combined emphysema and cancer, from radiology to prognosis in patients treated by immunotherapy: an ancillary study of a prospective multicenter phase II IFCT-1802 SAVIMMUNE - 26/08/26
, Ilyes Benlala 2, Alexandra Langlais 3, Laurent Greillier 4, Céline Mascaux 5, Francois Pinquie 6, Delphine Carmier 7, Lionel Moreau 8, Benoit Roch 9, Didier Debieuvre 10, Xavier Dhalluin 11, Etienne Giroux-Leprieur 12, Elodie Berton 13, Michael Duruisseaux 14, Judith Raimbourg 15, Audrey Rabeau 16, Adrien Dixmier 17, Charles Naltet 18, Virginie Westeel 19, Gérard Zalcman 20, Gael Dournes 2, Valérie Gounant 20Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder
Highlights |
• | Moderate emphysema was independently associated with poorer overall survival on durvalumab, among patients with PS≥2. |
• | Emphysema severity, rather than smoking status, may influence immunotherapy outcomes in advanced NSCLC. |
Abstract |
Introduction |
In studies evaluating the efficacy of anti-programmed cell death (ligand)1 (anti-PD-(L)1) in patients with non-small-cell lung cancer (NSCLC), smokers tend to have better clinical outcomes than non-smokers. However, whether co-existing emphysema is associated with differences in clinical outcomes, regardless of smoking status remains unclear.
Methods |
In a single-arm, prospective, multicenter, phase II trial, patients aged 18-75 years with metastatic NSCLC, PD-L1≥25% and a performance status (PS) of 2-3 received durvalumab until progression or toxicity. Pre-planned analyses classified emphysema visually as follows: <10% (no/mild emphysema), 10 to 25% (moderate emphysema) and >25% (severe emphysema). We also quantified emphysema (%LAV-950HU), along with bronchial (wall thickness) and small pulmonary vessels (cross-sectional area<5 mm²).
Results |
Fifty patients were enrolled with 49 analyzable CT scans, of whom 43 (87.8%) had emphysema. Twenty-eight patients (57%) had an emphysema extent >10%, with a median %LAV-950 HU of 0.97 [IQR: 0.25-3.12]. In univariate analyses, compared to mild emphysema, patients with moderate emphysema had a significantly poorer overall survival (OS (HR 2.73, 95%CI [1.25-5.98]), whereas severe emphysema had not. Objective response rate and progression free survival were similar in all groups. In multivariate analyses, OS remained lower in patients with moderate emphysema (HR: 2.53, 95%CI [1.12-5.71]), after adjustment for smoking, age and PS. There was no difference according to bronchial and vascular involvement.
Conclusion |
In a single-arm cohort of PS2-3 patients with advanced NSCLC treated with 1st-line durvalumab, the presence of moderate emphysema was associated with worse overall survival.
Le texte complet de cet article est disponible en PDF.Keywords : Emphysema, immune checkpoint inhibitors, durvalumab, NSCLC, poor performance status
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