WCLC 2025 - Posters & ePosters-P3.18.18 Predictive Role of Respiratory Function Tests on Lung Toxicity in Stage III NSCLC Under Chemo-Radiotherapy and Durvalumab: Preludio Trial

P3.18.18 Predictive Role of Respiratory Function Tests on Lung Toxicity in Stage III NSCLC Under Chemo-Radiotherapy and Durvalumab: Preludio Trial

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The PRELUDIO trial is a multicenter, observational study conducted in Italy evaluating the predictive role of pulmonary function tests (PFTs) for lung toxicity in patients with unresectable stage III non-small cell lung cancer (NSCLC) undergoing chemoradiotherapy (CRT) followed by durvalumab consolidation immunotherapy. Pneumonitis is a significant morbidity concern after CRT, complicating decisions on subsequent immunotherapy. Currently, diagnosis relies mainly on CT imaging, with no effective screening tools available in clinical practice, underscoring the need for reliable predictors.<br /><br />The study included 45 patients, predominantly male (71%), median age 67 years, many with smoking history and respiratory comorbidities (notably COPD). All received CRT, mostly sequentially, with radiotherapy totaling 60 Gy. Pulmonary toxicity was observed in 7 patients (15.5%), manifested as post-actinic pneumonia graded 2 to 4.<br /><br />PFTs assessed included spirometry (%FEV1, %FVC), diffusion capacity (DLCO), arterial blood gases, and six-minute walk test at multiple timepoints: baseline (Time 0), post-radiotherapy (Time 1), after immunotherapy cycles, and at treatment completion. Preliminary results suggest correlations between pulmonary toxicity and reductions in %FEV1 and %FVC. A negative trend was noted between DLCO values at baseline and post-RT in those developing lung toxicity, though statistical significance requires full data analysis.<br /><br />Baseline characteristics showed a median FEV1 around 77% predicted with lower values in the toxicity group. Other respiratory parameters and exercise tolerance were also monitored. The study emphasizes the importance of monitoring lung function to identify patients at higher risk for pneumonitis, aiming for earlier detection and intervention.<br /><br />In conclusion, PRELUDIO’s early findings support the potential prognostic value of PFTs, particularly FEV1, FVC, and DLCO, for predicting lung toxicity in stage III NSCLC treated with CRT and durvalumab. Further comprehensive analysis is needed to validate these preliminary correlations and improve management of pulmonary adverse effects in this patient population.

Asset Subtitle

Giuseppe Viscardi

Meta Tag

Speaker Giuseppe Viscardi

Topic Clinical Trials in Progress

Keywords

PRELUDIO trial

pulmonary function tests

lung toxicity

non-small cell lung cancer

stage III NSCLC

chemoradiotherapy

durvalumab consolidation

pneumonitis

spirometry

diffusion capacity