Comparative efficacy of immunotherapy-based treatment versus chemotherapy-only in patients with unresectable NSCLC with disease progression post chemoradiation and durvalumab

Abstract

Introduction

The current standard of care for fit patients with unresectable stage III NSCLC involves concurrent chemoradiation (CRT) followed by durvalumab. Disease recurrence occurs in approximately 2/3 of patients, often necessitating subsequent systemic therapy. The only available data about re-challenge immune checkpoint blockers (ICB) in this setting derives from small retrospective series. We evaluated progression free survival (PFS) and overall survival (OS) in patients receiving either ICB-based therapy versus a chemotherapy (CT)-only for disease progression after CRT and durvalumab.

Materials and methods

Multicenter retrospective study, conducted across 10 centers in Italy, the USA, Israel, and The Netherlands. Consecutive patients with relapsed NSCLC following CRT and durvalumab were enrolled.

Results

A total of 197 patients met the eligibility criteria: 93 received CT ( ± anti-VEGF), and 104 received an ICB-based treatment ( ± CT). The median PFS for patients receiving an ICB-based versus a CT-only regimen was 5.9 (95 % CI 4.3–7.6) versus 4.9 months (95 % CI 3.9–5.8), respectively (p = 0.011, HR: 0.67, 95 % CI 0.49–0.91). The median OS was 14.6 months (95 % CI 9.9–19.4) versus 8.9 (95 % CI 7.4–10.4), respectively (p = 0.005, HR: 0.61, 95 % CI 0.43–0.86). Patients with PFS ≥ 12 months on durvalumab, treated with subsequent ICB or CT median OS was 22.0 (95 % CI: 12.9–31.2) 9.8 months (95 % CI: 4.3–15.2) respectively (p = 0.024). Among patients with a PFS < 12 months on durvalumab there was no significant OS difference between ICB and CT arms.

Conclusions

ICB retreatment at disease progression after CRT and durvalumab might offer an OS benefit over CT in patients who do not relapse during durvalumab treatment.