964P PACIFIC on the West Coast: Exploring Reasons for Not Receiving Consolidative Durvalumab in the Treatment of Locally Advanced Lung Cancer

Standard treatment for locally advanced non-small cell lung cancers (NSCLC) is chemoradiotherapy (CRT) followed by a year of consolidative durvalumab (Antonia SJ, et al. NEJM, 2017). British Columbia started funding durvalumab for this indication in February 2020. Previous reports indicate close to half of eligible patients are not getting durvalumab (Denault MH, et al. JTO 2022). This study elaborates on reasons why patients did not get durvalumab in British Columbia, Canada from January 2020 to December 2021. Patients treated with concurrent chemoradiation from Jan 1, 2020 – Dec 31, 2021 were reviewed. Data was collected on systemic therapy, radiation therapy, timing between CRT and oncologist followup, biomarkers and reasons for not starting durvalumab. 371 patients underwent concurrent chemoradiation of which 171 patients did not get durvalumab. After chart review, 83 patients form the cohort of which 50 were stage 3A, 28 were stage 3B and 5 were stage 3C. 88 patients were excluded for the following reasons: durvalumab via access program (n=39), not completing curative dose radiation therapy (<50Gy; n=19), stage II or IV (n=22) and non-NSCLC pathology (n=8). 65 patients had PD-L1 testing: 24 were PD-L1 <1%, 23 were PD-L1 1-49% and 18 were PD-L1 >50%. In patients with biomarker testing, 12 were KRAS positive, 9 were EGFR positive and 3 were ALK positive. The top reason for not receiving durvalumab was progression (22; 26.5%). In 15 instances, durvalumab was either not discussed by the medical provider or declined by the patient. The next most common reasons were surgical resection (n=13), chemoradiation toxicity (n=11) and contraindications (n=10). Our cohort highlights a multitude of reasons why patients did not get immunotherapy after CRT with the most common being progression. Although not included in PACIFIC, trimodality therapy remains an option for locally advanced lung cancers in carefully selected patients. Toxicity secondary to chemoradiation did lead to durvalumab omission in some patients. This study highlights an opportunity to improve outcomes in locally advanced lung cancer in British Columbia, Canada using continued education about the benefit of consolidative durvalumab to both patients and providers.