ABSTRACT Introduction This retrospective study describes contemporary patterns of care and outcomes for early‐stage non‐small cell lung cancer (NSCLC) in Queensland, Australia, with a focus on immunotherapy. Methods Population‐based data for patients with NSCLC diagnosed at stages I‐III between 2018 and 2022 were sourced from the Queensland Oncology Repository. Follow‐up on treatment and mortality was available to 31 December 2024. Poisson models were used to determine patient and clinical characteristics associated with the treatments received. Differences in five‐year observed survival were calculated from multivariable flexible parametric models. Results The study cohort comprised 4608 patients. Surgery alone was the most common treatment modality for stages I and II (55% and 27%, respectively), whereas 44% of patients with stage III disease had concurrent chemoradiotherapy without surgery. Just over half (53%) of this latter group were also treated with durvalumab. First Nations people were somewhat less likely to receive either surgery (relative likelihood = 0.95, 95% CI 0.91–1.00; p = 0.04) or chemotherapy (RL = 0.95, 95% CI 0.90–0.99; p = 0.03) compared to other Queensland residents. Five‐year observed survival ranged from 17% (95% CI 11%–25%) for stage IIIC to 81% (95% CI 74%–87%) for stage IA1. Patients with unresected stage III disease who received concurrent chemoradiotherapy with subsequent durvalumab were 37% less likely to die from NSCLC within 5 years of diagnosis than chemoradiotherapy alone (hazard ratio = 0.63, 95% CI 0.51–0.78; p < 0.001). Conclusions Disparities in treatment for First Nation people with NSCLC require urgent attention. Durvalumab provides a survival advantage for unresectable stage III NSCLC within a real‐world setting.
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