Evaluating the effectiveness and safety outcomes of durvalumab maintenance after chemoradiotherapy for unresectable stage 3 non-small-cell lung cancer.

This study evaluated the effectiveness and safety outcomes of durvalumab (Imfinzi) maintenance after chemoradiotherapy (CRT) in real-world patients with unresectable stage 3 non-small-cell lung cancer (NSCLC). The data showed that durvalumab maintenance after CRT was safe and showed good short-term survival outcomes in these patients.

NSCLC is the most common form of lung cancer. NSCLC is responsible for around 85% of all lung cancer diagnoses. For patients with unresectable stage III NSCLC, the standard therapy consists of chemoradiotherapy (CRT) followed by durvalumab maintenance for responding patients. CRT involves administering both chemotherapy (CT) and performing radiation therapy (RT).

There are two strategies for delivering CRT in NSCLC. The first strategy is called concomitant CRT (cCRT). This involves administering both CT and RT during the same treatment period. The second approach is called sequential CRT (sCRT). This involves first administering CT. Once completed, RT is performed. This can also mean giving RT first followed by CT. sCRT may be better tolerated than cCRT.

Durvalumab is an immunotherapy and has been found to improve survival outcomes in patients with unresectable advanced NSCLC. Tumor cells try to avoid death by switching off the immune system. They bind to proteins on the surface of the immune cells such as PD-1/PD-L1. Immune checkpoint inhibitors (ICI) such as durvalumab block these interactions and turn on the immune system to attack and kill the cancer cells.

A previous clinical trial has shown that durvalumab administered after CRT in patients with stage 3 unresectable NSCLC improves the outcomes of patients. However, in a real-world setting patients may be very different compared to those included in clinical trials. They are usually older and can also have other medical conditions that can influence treatment effectiveness and tolerability. Therefore, it is important to evaluate the effectiveness and safety of durvalumab maintenance after CRT in real-world patients.

This study involved 155 patients with unresectable stage 3 NSCLC who were treated with CRT followed by at least one dose of durvalumab. 91 patients had received cCRT and 64 sCRT before durvalumab therapy. The average follow-up time was 14 months.

97.2% of the patients were alive after 12 months. 87.9% were alive after 18 months and 79.3% were alive after 24 months.

The average survival without cancer worsening was 23 months. 83.5% of the patients were alive after 12 months without cancer worsening. After 2 years, 53.1% were alive without cancer worsening. There was no significant difference in survival between patients who received cCRT and sCRT before durvalumab. 

Overall, 49% of the patients experienced immune-related side effects. The most common side effect was mild inflammation of the lining of the esophagus (the tube that connects the throat and the stomach; 50.3%).

This study concluded that durvalumab maintenance after CRT was safe and showed good short-term survival outcomes in real-world patients with unresectable stage III NSCLC.

The follow-up time was too short and the study looked back in time at medical records. This study was funded by AstraZeneca, the manufacturer of durvalumab.