Immune Checkpoint Inhibitors After Chemoradiation in Unresectable Non–Small Cell Lung Cancer: Survival Outcomes From a Tertiary Care Center in Lebanon

To evaluate real-world survival outcomes of consolidation immunotherapy after concurrent chemoradiotherapy (cCRT) in patients with unresectable stage III non-small cell lung cancer (NSCLC) treated at a tertiary cancer center in Lebanon. This is a retrospective cohort study that included patients with unresectable stage III NSCLC treated between 2019 and 2025 with definitive cCRT, with or without ICIs (durvalumab or atezolizumab). The primary endpoint was progression-free survival (PFS), analyzed using Kaplan-Meier and Cox regression methods, adjusting for variables, including PD-L1 status. Among 92 eligible patients, 52 (56.5%) received consolidation immunotherapy, and 40 (43.5%) received cCRT alone. Median follow-up was 22.3 months. Median PFS was 19.0 months (95% CI: 12.8-25.2) with ICIs versus 10.0 months (95% CI: 7.0-13.1) without (log-rank P=0.210). On multivariable Cox analysis, immunotherapy was associated with a favorable trend toward improved PFS (HR=0.53, 95% CI: 0.26-1.11; P=0.09). PD-L1 positivity independently predicted longer PFS (HR=0.42, 95% CI: 0.21-0.84; P=0.014), while high tumor grade predicted inferior outcomes (HR=1.89, 95% CI: 1.04-3.43; P=0.038). Immunotherapy after cCRT was associated with numerically and clinically meaningful improvement in PFS, consistent with the landmark PACIFIC trial. PD-L1 expression emerged as an independent prognostic and predictive biomarker, supporting biomarker-driven treatment strategies. These findings validate the clinical benefit of ICIs in a Middle Eastern low- and middle-income setting, reinforcing the importance of equitable access to immunotherapy.