Chemoradiation followed by adjuvant durvalumab in stage III non–small cell lung cancer: Real-world comparison of treatment outcomes to historical controls treated with chemoradiation alone

Akram Saad*, Jeffrey Goldstein, Sarit Appel, Sameh Daher, Damien Urban, Amir Onn, Hadas Gantz-Sorotsky, Anastasiya Lobachov, Teodor Gottfried, Benjamin Spieler, Jair Bar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Compare outcomes in patients with stage III non–small cell lung cancer (NSCLC) treated with chemoradiation and adjuvant durvalumab to historical controls treated with chemoradiation alone. Methods: The records of patients with stage III NSCLC treated with definitive chemoradiation ± adjuvant durvalumab were reviewed retrospectively. Primary endpoints were progression free survival (PFS), overall survival (OS), and adverse events (AE). Results: Between September 2009 and September 2020, 215 patients were treated with concurrent chemoradiation (n = 144) or concurrent chemoradiation followed by adjuvant durvalumab (n = 71). Compared to historical controls, durvalumab use was associated with improved PFS: median (27 months vs. 10 months, p < 0.0001), 1-year (83.1% vs. 43.8, p < 0.0001); and improved OS; median (not reached vs. 24 months, p < 0.0001), 1-year (85.9% vs. 81.9%, p < 0.0001). Multivariate analysis showed adjuvant durvalumab was associated with increased OS (p = 0.005) and PFS (p = 0.001). Within the durvalumab group, only clinical stage IIIA versus IIIB/C was associated with improved OS (p = 0.049), but not PFS. There was no association between PFS or OS and Eastern Cooperative Oncology Group (ECOG) score, prior history of immune disease, programmed death-ligand 1 (PD-L1) receptor status, delay in starting durvalumab beyond 42 days, or development of an AE. During durvalumab treatment, 63 AE were reported in 52 patients with treatment discontinuation in 11. Pneumonitis was the most common AE reported (n = 35, 49%). Most AE were grade 1–2 (n = 57). Grade 3–4 AE were uncommon (n = 6) and none were grade 5. Conclusion: Treatment with adjuvant durvalumab following chemoradiation was associated with improved PFS and OS compared to chemoradiation alone.

Original languageEnglish
Pages (from-to)1763-1771
Number of pages9
JournalThoracic Cancer
Volume13
Issue number12
DOIs
StatePublished - Jun 2022

Funding

FundersFunder number
Bristol-Myers Squibb
AstraZeneca
Novartis
Roche
AbbVie
Takeda Pharmaceutical Company
Merck Sharp and Dohme

    Keywords

    • PD-L1
    • durvalumab
    • immunotherapy
    • non–small cell lung cancer
    • stage III

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