Durvalumab consolidation after definitive chemoradiotherapy (CRT) is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC) but real-world data comparing PD-L1-defined subgroups are limited. This retrospective single-centre study analyzed overall survival (OS) and progression-free survival (PFS) in 142 patients with inoperable stage III NSCLC with definitive CRT between 2015 and 2022. All tumours were assessed for PD-L1 expression, including retrospective testing, where required. Patients were assigned into three cohorts: PD-L1-positive with (PD-L1+mD; n = 57) and without (PD-L1+oD; n = 44) durvalumab maintenance and PD-L1-negative without durvalumab (PD-L1−oD; n = 41). Mean follow-up was 44.0 months. Median OS was 27.3, 15.1 and 23.4 months for PD-L1+mD, PD-L1+oD, and PD-L1−oD, respectively. Median PFS was 18.4, 10.5 and 13.4 months for PD-L1+mD, PD-L1+oD, and PD-L1−oD, respectively. OS and PFS were significantly improved with durvalumab in PD-L1-positive patients (p = 0.043 and p = 0.027). PD-L1-negative patients showed no significant OS or PFS differences versus PD-L1+oD. Immunotherapy-related pneumonitis ≥grade 1 was documented in 15.7% patients. In real-world practice, durvalumab improves OS and PFS in PD-L1-positive unresectable stage III NSCLC and its omission appears particularly unfavourable.
Selke et al. (Wed,) studied this question.