Outcomes of Patients with Unresectable Stage III Non–Small-Cell Lung Cancer Treated with Durvalumab After Chemoradiotherapy

Introduction:This study evaluated the efficacy and safety of durvalumab in unresectable stage III non-small-cell lung carcinoma (NSCLC) at a tertiary centre in Hong Kong.Methods: Cases of stage III NSCLC treated with radical-intent chemoradiotherapy (CRT), with or without durvalumab, from December 2017 to June 2023 were included.Outcomes, including progression-free survival (PFS) and overall survival (OS), were analysed using the Kaplan-Meier method.Adverse events, including anygrade pneumonitis and the Common Terminology Criteria for Adverse Events grade 3 immune-related adverse events, were reviewed.Results: A total of 113 cases were analysed (51 cases of durvalumab plus CRT and 62 cases of CRT).The durvalumab plus CRT cohort demonstrated a significantly longer median PFS compared to the CRT cohort (34.9 vs. 10.5 months; p = 0.01), while median OS remained immature at the time of analysis.Among patients with epidermal growth factor receptor (EGFR) mutations, the estimated PFS also favoured the durvalumab plus CRT cohort.A significantly higher incidence of any-grade pneumonitis was observed in the durvalumab plus CRT cohort (31% vs. 8%; p = 0.002), with most cases occurring within the initial 3 months of durvalumab use. Conclusion:Durvalumab following CRT significantly benefitted patients with unresectable stage III NSCLC, including those with EGFR mutations.Symptomatic pneumonitis tended to occur in the first 3 months of durvalumab therapy and was generally manageable.Closer follow-up during this period is recommended to facilitate early detection and intervention.Further research is warranted to understand the complex interplay among EGFR mutation status, programmed death ligand 1 expression, and treatment outcomes with and without durvalumab in NSCLC.