Real-world management of unresectable stage III non-small-cell lung cancer: Impact of durvalumab consolidation therapy in French clinical practice.

[BACKGROUND] Durvalumab consolidation therapy has improved survival after chemoradiotherapy in patients with advanced non-small-cell lung cancer (NSCLC). Our three-cohort study from France described the real-world effectiveness and safety of durvalumab in unresectable stage III NSCLC.

[METHODS] We analysed three durvalumab-treated cohorts: the French PACIFIC-R cohort (n=342), the prospective KBP-2020-CPHG cohort (n=178), and the ESME lung cancer registry (n=604). Progression-free survival (PFS) and overall survival (OS) were assessed from start of durvalumab (in French PACIFIC-R and KBP-2020-CPHG) or end of radiotherapy (in ESME). Safety data were available for the French PACIFIC-R cohort.

[RESULTS] In French PACIFIC-R, at a median follow-up of 39.4 months, median PFS was 22.6 months and median OS was not reached. At 3 years, OS was 61.1%. Median PFS was 13.0 months in patients with programmed death-ligand 1 (PD-L1) expression <1% versus 25.3 months in those with PD-L1 ≥1%. Pneumonitis/interstitial lung disease occurred in 17.8% of patients, with no fatal events. In KBP-2020-CPHG, median PFS was 18.5 months and median OS was not reached. Three-year OS was 55.0%. Patients with PD-L1 expression >50% had a 3-year OS rate of 68.4% compared to 48.5% in those with PD-L1 expression 1%-50%. In ESME, median PFS was 21.2 months and median OS was 50.7 months. The 3-year and 5-year OS rates were 61.3% and 46.9%, respectively. Among 308 patients with N2 stage disease, median PFS was 25.6 months and median OS was 56.4 months from NSCLC diagnosis.

[CONCLUSIONS] Real-world evidence from three large French cohorts underscores the sustained effectiveness and manageable safety profile of durvalumab consolidation therapy after chemoradiotherapy in unresectable stage III NSCLC.