Accompanying immunotherapy and quality of life in patients with locally advanced non-small cell lung cancer who received simultaneous chemoradiotherapy

Background. Lung cancer continues to be in the leading positions in mortality among all malignant neoplasms; 85 % of all cases are nonsmall cell lung cancer (NSCLC), and in 40 % of patients the process is diagnosed at a common unresectable stage. Chemoradiotherapy is the standard of treatment for this category of patients, which allows to improve the results of local control and overall survival. In Russia, chemoradiotherapy accounts for about 4 % of all treatment methods. Perhaps this is due to high toxicity of this method and, as a result, a deterioration in quality of life of patients.

Aim. To assess the quality of life of patients with locally advanced NSCLC during simultaneous chemoradiotherapy in combination with and without accompanying immunotherapy.

Materials and methods. The study included 60 patients with locally advanced NSCLC. The study group (n = 30) received a radical course of simultaneous chemoradiotherapy with the use of accompanying immunotherapy with azoximer bromide. Patients in the control group (n = 30) underwent a course of simultaneous chemoradiotherapy in the standard mode. We evaluated the criteria of quality of life in patients using questionnaires EORTC QLQ-LC13, EQ-5D-5L, EORTC QLQ-C30.

Results. In the study group, an improvement in most of the parameters of quality of life and a decrease in the severity of symptoms were demonstrated compared with the control group.

Conclusion. The study demonstrated a tendency to reduce hematological toxicity and improve the quality of life of patients with NSCLC. This allows us to consider the possibility of using accompanying immunotherapy in combination with chemoradiotherapy as an additional therapeutic option that improves the quality of life of patients and the tolerability of the treatment.

1. The state of cancer care for the population of Russia in 2022. Ed. by A.D. Kaprin, V.V. Starinsky, A.O. Shakhzadova. Moscow: MNIOI im. P.A. Gertsena - filial FGBU “NMITS radiologii” Minzdrava Rossii, 2022. (In Russ.).

2. Malignant neoplasm of the bronchi and lung. Clinical recommendations of the Ministry of Health of the Russian Federation. Moscow, 2021. (In Russ.). Available at: https://oncologyassociation.ru/wp-content/uploads/2021/02/rak-legkogo-2021.pdf

3. Polanski J., Jankowska-Polanska B., Rosinczuk J. et al. Quality of life of patients with lung cancer. Onco Targets Ther 2016;9:1023-8. DOI: 10.2147/OTT.S100685

4. Gralla R.J. Quality-of-life considerations in patients with advanced lung cancer: effect of topotecan on symptom palliation and quality of life. Oncologist 2004;9(Suppl 6):14-24. DOI: 10.1634/theoncologist.9-90006-14

5. Camps C., del Pozo N., Blasco A. et al. Importance of quality of life in patients with non-small-cell lung cancer. Clin Lung Cancer 2009;10(2):83-90. DOI: 10.3816/CLC.2009.n.010

6. Outcomes of cancer treatment for technology assessment and cancer treatment guidelines. American Society of Clinical Oncology. J Clin Oncol 1996;14(2):671-9. DOI: 10.1200/JCO.1996.14.2.671

7. Filonenko E.V. Optimization of chemotherapy in patients with advanced lung cancer. Dis. ... of candidate of medical sciences. Ufa, 2004. (In Russ.).

8. Offin M., Shaverdian N., Rimner A. et al. Clinical outcomes, localregional control and the role for metastasis-directed therapies in stage III non-small cell lung cancers treated with chemoradiation and durvalumab. Radiother Oncol 2020;149:205-11. DOI: 10.1016/j.radonc.2020.04.047

9. Raben D., Rimner A., Senan S. et al. Patterns of disease progression with durvalumab in stage III non-small cell lung cancer (PACIFIC). Int J Radiat Oncol Biol Phys 2019;105(3):683-3. DOI: 10.1016/j.ijrobp.2019.08.034

10. Jiang N., Chen X.C., Zhao Y. Analysis of the risk factors for myelosuppression after concurrent chemoradiotherapy for patients with advanced non-small cell lung cancer. Support Care Cancer 2013;21(3):785-91. DOI: 10.1007/s00520-012-1580-y

11. Alexia C., Cren M., Louis-Plence P. et al. Polyoxidonium® activates cytotoxic lymphocyte responses through dendritic cell maturation: clinical effects in breast cancer. Front Immunol 2019;10:2693. DOI: 10.3389/fimmu.2019.02693

12. Grivtsova L.Y., Falaleeva N.A., Tupitsyn N.N. Azoximer bromide: mystery, serendipity, and promise. Front Oncol 2021;11:699546. DOI: 10.3389/fonc.2021.699546

13. Pružinec P., Chirun N., Sveikata A. The safety profile of Polyoxidonium in daily practice: results from postauthorization safety study in Slovakia. Immunotherapy 2018;10(2):131-7. DOI: 10.2217/imt-2017-0116

14. Petrov R. V., Khaitov P. M., Nekrasov A.V. et al. Polyoxidonium - mechanism of action and clinical relevance. Meditsinskaya immunologiya = Medical Immunology 2000:2(3):271-8. (In Russ.). Available at: https://cyberleninka.ru/article/n/polioksidoniy-mehanizm-deystviya-i-klinicheskoe-primenenie.