Predictive factors for cardiac events following concurrent chemotherapy and radiation with durvalumab consolidation for unresectable non-metastatic non-small cell lung cancer.

12033 Background: The PACIFIC trial was a randomized phase 3 study which evaluated the use of Durvalumab as consolidation therapy after definitive chemoradiation for patients with unresectable non-metastatic NSCLC. There was a significant improvement in progression free survival and overall survival. It was established as a standard approach for management. Due to nonspecific activation of the immune system, immune related adverse events are commonly associated with ICIs. Immune related cardiotoxicity is less common however may present as arrhythmia, pericarditis, valvular disease, cardiomyopathy, and there is more recent data to suggest an acceleration of atherosclerotic plaque burden likely due to inflammation that can result from immune activation. In this population, there are usually several other risk factors for cardiac disease including age, history of tobacco use, exposure to cardiotoxic chemotherapy and chest radiation. The objective of this study is to quantify, characterize, and identify potential risk factors for cardiac events (CEs) that occur after exposure to concurrent chemotherapy and radiation followed by Durvalumab in patients with unresectable non-metastatic NSCLC. Methods: Patients who received concurrent chemotherapy and radiation followed by Durvalumab for treatment of NSCLC at a large academic medical center between January 1, 2017 and April 1, 2021 were retrospectively identified. Demographics, treatment history, cardiovascular comorbidities (pre-existing arrhythmia, coronary artery disease, diabetes mellitus, heart failure, hypertension, hyperlipidemia, cerebral vascular accident, peripheral artery disease, tobacco use) and CEs occurring within 5 years of treatment were collected by chart review. Logistic regression analysis was used to identify potential risk factors for cardiac events in this patient population. Results: Among 115 patients, 29 (25%) experienced CEs including 15 new/worsening arrhythmia, 11 new/worsening cardiomyopathy, and 9 new/worsening coronary artery disease. There were no cardiac deaths identified. The most common arrhythmia was atrial fibrillation. Pre-existing arrhythmia, dyslipidemia, and number of pack years showed significant association with cardiac events (p<0.05). Cumulative dose of radiation was found to be marginally significant on logistic regression analysis (p=0.07). Patients on a statin had a slightly lower odds of cardiac event (OR 0.03, p=0.02). Conclusions: Cardiac events following exposure to concurrent chemotherapy and Durvalumab may occur in up to 25% of patients with unresectable non-metastatic NSCLC. Further retrospective analysis of changes in coronary atherosclerotic plaque burden across PET-CT with ICI exposure and correlation with cardiac events is underway.