Treatment outcomes in locally advanced, unresectable NSCLC treated with concurrent chemoradiation and PD-L1 consolidation: Real-world data from a NCI comprehensive cancer center with a racially diverse, high poverty catchment area.

This is the authors' abstract. We don't add key points for this paper.

8067 Background: The PACIFIC trial established concurrent chemoradiotherapy (CCRT) followed by consolidation durvalumab as standard of care for unresectable stage III non-small cell lung cancer (NSCLC). This study showed a progression free survival (PFS) of 16.9 mo and an overall survival (OS) of 47.5 mo. There is a paucity of real world data with PACIFIC, especially in diverse patient populations. We present real world outcomes of the PACIFIC regimen in a NCI-designated comprehensive cancer center (CCC) with a racially diverse, high poverty catchment area. Methods: Retrospective chart review identified patients treated with durvalumab for NSCLC after CCRT per PACIFIC. Demographic data included sex, race, age, stage, address, smoking status, immunotherapy adverse events (irAE). Poverty index was assessed using the SAIPE tool by percent of children in poverty at the school district level based off 2021 census and stratified to above and below 15.1%. Annual air particulate matter (PM) 2.5 was obtained at the zip code level from the Socioeconomic Data and Applications Center. PFS was from date of first dose durvalumab; OS was from date of NSCLC diagnosis to death or last follow up. Results: 203 patients with unresectable NSCLC were included. Of these, 18.2% were of Black race compared to 2.0% in the PACIFIC trial. 42.4% of patients lived in high poverty areas, 44.3% were current smokers. Patients had a median annual PM 2.5 exposure of 7.9 ug/m 3 . 42.7% had PD-L1 expression >50%. The irAE rate was 27.6% (Table 1). Overall median PFS was 23 mo (95% CI 16.1-31.9) and 28.2 mo (95% CI 11.1-50.7) for patients of Black race. Overall median OS was 52.4 mo (95% CI 31.2-NR) and 52.4 mo (95% CI 18.2-NR) for Black patients. Conclusions: In this diverse cohort treated with the PACIFIC regimen at a NCI CCC, favorable real world PFS (23.0 vs. 16.9 mo), and OS (52.4 vs. 47.5 mo) were demonstrated. This cohort is more representative of the US patient population than that of a stringent clinical trial population with at least comparable results. This unexpected result may arise from institutional practices leading to equitable access to care and other biological characteristics of the population. Clinical trial enrollment representative of the broader population remains paramount for equitable care delivery. [Table: see text]