Should Post-CCRT Durvalumab Be an Option for Older Patients With Unresectable Stage III NSCLC?

A new study suggests that age alone should not exclude patients with unresectable stage III non-small cell lung cancer (NSCLC) from receiving durvalumab after concurrent chemoradiotherapy (CCRT).

A team from Hallym University Dongtan Sacred Heart Hospital conducted the study and presented their findings during the American Thoracic Society 2024 International Conference. The researchers explained that consolidation durvalumab following CCRT has significantly improved progression-free survival (PFS) and overall survival (OS) in patients with unresectable stage III NSCLC, but “evidence for this approach in elderly patients is lacking.”

To address questions surrounding the use of this regimen in older adults, the investigators reviewed data from all patients with unresectable stage III NSCLC who received durvalumab after CCRT at 4 Korean hospitals from 2020 to 2023. The researchers analyzed patients by age, grouping them into those younger than 70 years (n=15) and those 70 years and older (n=7). The investigators performed a sensitivity analysis for patients aged 65-75 years. The study end points were PFS, OS, and adverse events (AEs).

The investigators found that patient baseline characteristics, including Eastern Cooperative Oncology Group (ECOG) performance status, and comorbidities “were similar” between age groups. However, the number of smoking pack-years was higher in the older patients (53 smoking pack-years) than in the younger patients (37 smoking pack-years; P=.004). The total radiation dose also differed between groups, as the older patients received an average of 60 Gray and younger patients received an average of 66 Gray (P=.010).

When adjusted for smoking pack-years; ECOG performance status; comorbidities, including diabetes mellitus and chronic obstructive pulmonary disease; and total radiation dose, the older and younger patients showed similar PFS (hazard ratio [HR], 1.57; 95% CI, 0.38-6.52 and HR, 8.69; 95% CI, 0.31-243.13, respectively). The median PFS was 16.6 months in older patients and 29.8 months in younger patients (P=.533). The study authors reported that “even at ages 65 and 75, there was no significant difference in PFS” between the 2 groups (HR, 1.72; 95% CI, 0.18-16.50 and HR, 2.92; 95% CI, 0.10-82.34, respectively).

The median OS was not reached in the older or younger age groups, and there was no significant difference in the incidence of grade 3 or higher immune-related AEs between age groups.

“Durvalumab after CCRT showed PFS and OS benefit and a tolerable safety profile in patients with unresectable stage III NSCLC, regardless of age,” the study authors concluded. “Therefore, eligible patients should not be excluded and undertreated from receiving durvalumab after CCRT based on their age alone.”

Reference

Kim SJ, Kim NY, Chung S, et al. Treatment outcome and safety of durvalumab after concurrent chemoradiotherapy in elderly patients with unresectable stage III non-small cell lung cancer. Presented at the American Thoracic Society 2024 International Conference; May 17-22, 2024; San Diego, California.