Radiotherapy patterns and factors associated with pneumonitis in PACIFIC-R, a real-world study of patients with unresectable stage III non-small-cell lung cancer treated with durvalumab after chemoradiotherapy

Filippi AR, Bar J, Christoph DC, Field JK, Fietkau R, Garassino MC, Garrido P, Haakensen VD, Kao S, McDonald F, Mornex F, Moskovitz M, Peters S, Van Den Heuvel MM, Vercauter P, Smit HJ, Solomon B, Chander P, Qiao Y, Faria J, Girard N (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Article Number: 101138

DOI: 10.1016/j.ctro.2026.101138

Abstract

Background and purposeConsolidation durvalumab, standard-of-care treatment for patients with unresectable stage III non-small-cell lung cancer (NSCLC) and no disease progression after chemoradiotherapy, may be associated with pneumonitis. We performed exploratory analyses of radiotherapy patterns and potential risk factors for symptomatic pneumonitis (SP) in PACIFIC-R.Materials and methodsPACIFIC-R is an ongoing, international, observational study based on medical chart data for patients in the durvalumab early access program. Patients with no missing data for candidate SP risk factors were included. SP was defined as a pneumonitis event (any cause) of grade ≥ 2 or requiring corticosteroids. Multivariable logistic regression identified variables associated with SP during durvalumab treatment; sensitivity analyses used a Cox proportional hazards model to account for time to SP.ResultsAnalyses included 268 patients; most received concurrent (86.6%) versus sequential (13.4%) chemoradiotherapy and intensity-modulated (IMRT; 66.8%) versus three-dimensional conformal (25.7%) radiotherapy, with between-country differences. Patients receiving IMRT were older, more frequently had nonsquamous histology, and had larger tumors. Fifty-two patients (19.4%) had SP during durvalumab treatment. Higher mean lung radiotherapy dose (log transformed) and prior chronic obstructive pulmonary disease (COPD) were associated with higher SP risk, with odds ratios (95% confidence interval [CI]) of 4.73 (1.66–15.07) and 2.60 (1.21–5.65), respectively, and hazard ratios (95% CI) of 3.28 (1.54–6.95) and 1.93 (1.04–3.56), respectively.ConclusionsConcurrent chemoradiotherapy and IMRT were the most common radiotherapy approaches. Higher mean lung radiotherapy dose and prior COPD were associated with higher SP risk during consolidation durvalumab for unresectable stage III NSCLC.

Authors with CRIS profile

Involved external institutions

Università degli Studi di Pavia Italy (IT) Tel Aviv University Israel (IL) Evangelisches Krankenhaus Herne Germany (DE) The University of Liverpool United Kingdom (GB) University of Chicago United States (USA) (US) Universidad de Alcalá (UAH) Spain (ES) Oslo University Hospital / Oslo Universitetssykehus Rikshospitalet Norway (NO) Chris O’Brien Lifehouse Australia (AU) Royal Marsden Hospital / The Royal Marsden NHS Foundation Trust United Kingdom (GB) Hospices Civils de Lyon (CHU) France (FR) Rambam Health Care Campus Israel (IL) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Radboud University Nijmegen Medical Centre / Radboudumc of voluit Radboud Universitair Medisch Centrum (UMC) Netherlands (NL) Onze-Lieve-Vrouwziekenhuis (OLV Ziekenhuis, OLVZ) Belgium (BE) Rijnstate Ziekenhuis Netherlands (NL) Peter MacCallum Cancer Centre Australia (AU) University of Cambridge United Kingdom (GB) Institut Curie France (FR)

How to cite

APA:

Filippi, A.R., Bar, J., Christoph, D.C., Field, J.K., Fietkau, R., Garassino, M.C.,... Girard, N. (2026). Radiotherapy patterns and factors associated with pneumonitis in PACIFIC-R, a real-world study of patients with unresectable stage III non-small-cell lung cancer treated with durvalumab after chemoradiotherapy. Clinical and Translational Radiation Oncology. https://doi.org/10.1016/j.ctro.2026.101138

MLA:

Filippi, Andrea R., et al. "Radiotherapy patterns and factors associated with pneumonitis in PACIFIC-R, a real-world study of patients with unresectable stage III non-small-cell lung cancer treated with durvalumab after chemoradiotherapy." Clinical and Translational Radiation Oncology (2026).

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