Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, U.S.A.;
Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, U.S.A.
Anticancer Res. 2024 Feb;44(2):605-612. doi: 10.21873/anticanres.16849.
BACKGROUND/AIM: The PACIFIC trial demonstrated improved survival in patients with unresectable stage III non-small cell lung cancer (NSCLC) treated with durvalumab following definitive concurrent chemoradiotherapy (CRT). This study sought to explore real-world outcomes with durvalumab consolidation therapy at our institution.
We retrospectively identified patients diagnosed with stage III NSCLC at our institution from January 2012 to January 2022. We created two cohorts: one who received durvalumab following definitive CRT and a historical one who did not. Primary outcomes of interest included median progression-free survival (PFS) and overall survival (OS). Additionally, we performed subgroup analysis on the durvalumab cohort to explore the associations between survival and time to durvalumab initiation, PD-L1 expression, and neutrophil-to-lymphocyte ratio (NLR).
We identified 79 patients with locally advanced NSCLC who were not surgical candidates. Patients treated with durvalumab (n=44) had significantly improved survival compared to the historical cohort (n=35) including a median PFS of 17.4 months versus 8.0 months (p=0.0019) and a median OS of 37.0 months versus 17.0 months (log-rank p-value=0.07, Wilcoxon p-value=0.02). Within the durvalumab group, outcomes did not significantly differ between those who initiated therapy before or after 42 days of finishing CRT, between various PD-L1 expression levels, or between high or low NLR.
Patients who received durvalumab as consolidation therapy following definitive CRT demonstrated significantly improved survival compared to a historical cohort who did not receive durvalumab. Furthermore, durvalumab appears to benefit patients regardless of time to initiation, PD-L1 expression, or NLR.
背景/目的：PACIFIC 试验表明，在接受根治性同步放化疗（CRT）后接受 durvalumab 治疗的不可切除 III 期非小细胞肺癌（NSCLC）患者中，生存得到改善。本研究旨在探讨我院 durvalumab 巩固治疗的真实世界结果。
我们回顾性地从 2012 年 1 月至 2022 年 1 月在我院诊断为 III 期 NSCLC 的患者。我们创建了两个队列：一个是在接受根治性 CRT 后接受 durvalumab 治疗的队列，另一个是没有接受 durvalumab 治疗的历史队列。主要研究终点包括中位无进展生存期（PFS）和总生存期（OS）。此外，我们对 durvalumab 队列进行了亚组分析，以探讨生存与 durvalumab 起始时间、PD-L1 表达和中性粒细胞与淋巴细胞比值（NLR）之间的关系。
我们确定了 79 名局部晚期 NSCLC 患者，他们不适合手术。接受 durvalumab 治疗的患者（n=44）与历史队列（n=35）相比，生存显著改善，包括中位 PFS 为 17.4 个月对 8.0 个月（p=0.0019）和中位 OS 为 37.0 个月对 17.0 个月（对数秩检验 p 值=0.07，Wilcoxon 检验 p 值=0.02）。在 durvalumab 组中，在 CRT 结束后 42 天之前或之后开始治疗的患者之间、不同 PD-L1 表达水平之间或高或低 NLR 之间，结局没有显著差异。
与未接受 durvalumab 治疗的历史队列相比，接受根治性 CRT 后接受 durvalumab 作为巩固治疗的患者生存显著改善。此外，durvalumab 似乎使患者受益，无论起始时间、PD-L1 表达或 NLR 如何。
