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In a patient with both Stage III NSCLC and another concurrent high risk malignancy, how do you sequence consolidation durvalumab with local therapy for the concurrent cancer?
Lately I have seen patients with a concurrent gynecologic (requiring chemoRT), head and neck (requiring surgery), and early stage NSCLC (requiring SBRT). Often the Stage IIII NSCLC is the most high risk and requires chemoradiation first, but after completing treatment, we are unsure if durvalumab should be delayed to treat the other malignancy or if treatment of the other cancer should be done between IO cycles.
Answer from: Radiation Oncologist at Academic Institution
I pretty frequently see either 1) concurrent LA-HNSCC and stage III lung, or 2) concurrent stage III and stage I NSCLCs. I wouldn't pause or delay the durva in either scenario. Quite a bit of literature now supporting the safety of concurrent RT (even high dose per fraction/SBRT) and immune checkpoi...
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Answer from: Radiation Oncologist at Community Practice
We are in a data free zone regarding the safety of concurrent durva + RT that delivers full doses to a mucosal structure until we see AE data from PACIFIC-2.