Factors predicting early recurrence in patients with unresectable stage III non-small cell lung cancer on durvalumab consolidation after chemoradiotherapy.

BACKGROUND

Durvalumab consolidation after concurrent chemoradiotherapy (CCRT) is the present standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC). However, some patients experience early recurrence. This study sought risk factors for early recurrence during durvalumab consolidation.

METHODS

This retrospective multicenter study was conducted between September 2017 and September 2022. We categorized patients into early and non-early recurrence groups. Early recurrence was defined as recurrence within 6 months after the first dose of durvalumab.

RESULTS

Of the 222 patients, 40 (18.0%) experienced early recurrence and 182 (82.0%) experienced non-early recurrence. The former group was younger than the latter group (P=0.02). Patients exhibiting lower-level programmed cell death-ligand 1 (PD-L1) expression were more likely to experience early recurrence (P=0.02). Stage IIIC patients tended to experience more early recurrence than stage IIIA/IIIB patients (P=0.055). Multivariate analyses revealed that older age [odds ratio (OR), 0.945; 95% confidence interval (CI): 0.902-0.991; P=0.02] and PD-L1 level ≥50% (OR, 0.303; 95% CI: 0.125-0.736; P=0.008) protected against early recurrence in NSCLC patients on durvalumab consolidation. Median overall survival was significantly longer in the non-early recurrence group than in the early recurrence group (non-evaluable 11.0 months, respectively; P<0.001).

CONCLUSIONS

Younger age and lower PD-L1 expression predicted early recurrence during durvalumab consolidation after CCRT. Careful follow-up of such patients is essential.