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Durvalumab Pneumonitis Risk — SCE Medical Oncology MCQ

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ModerateLung CancerDurvalumab Pneumonitis RiskSCE Medical Oncology

A 62-year-old man with stage IIIB NSCLC (T4 N2 M0) completes concurrent chemoradiation and is planned for durvalumab consolidation. His pre-durvalumab CT shows no progression. What key toxicity must be monitored during durvalumab maintenance?

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Correct answer: A — Pneumonitis — the most clinically significant toxicity of durvalumab after thoracic RT, occurring in approximately 12-15% (any grade), ~3-4% grade 3+; prior thoracic radiation increases the risk

Pneumonitis is the most important toxicity of durvalumab consolidation after chemoRT, with higher rates than ICI without prior thoracic RT (~12-15% vs ~3-5%). The prior radiation creates a primed inflammatory milieu in the lung. Monitoring includes: symptom assessment at each cycle, pulse oximetry, and CT with each restaging scan. Patients should be counselled about reporting new cough or dyspnoea urgently. Grade 2+ pneumonitis requires durvalumab hold ± corticosteroids; grade 3+ mandates permanent discontinuation.

Reference: NICE TA798 Durvalumab; PACIFIC safety data; ESMO 2024 NSCLC