Real-World Outcomes of Consolidation Durvalumab After Chemoradiotherapy in Unresectable Stage III Non-Small Cell Lung Cancer: A Retrospective Cohort Study From Vietnam.

Abstract

Introduction: Durvalumab administered after definitive chemoradiotherapy has changed the treatment landscape for patients with unresectable stage III non-small cell lung cancer (NSCLC). Evidence describing treatment outcomes in routine clinical settings, particularly in Southeast Asian populations, remains relatively limited.

Methods: We performed a retrospective cohort study at the Vietnam National Cancer Hospital including consecutive patients treated with consolidation durvalumab following concurrent chemoradiotherapy between March 2021 and June 2025. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), objective response rate (ORR), and safety. Prespecified subgroup analyses evaluated outcomes according to age, molecular alteration status, and timing of durvalumab initiation.

Results: Seventy-nine patients were analyzed, with a median follow-up of 32.9 months (95% CI: 30.9-37.0 months). The mean age was 59.5 ± 9.3 years, and 79.7% were male; 60.7% were current or former smokers with an ECOG 0. Non-squamous histology accounted for 81% of cases, and EGFR or ALK alterations were identified in 27.8%. The ORR was 32.9%. Median PFS was 29.8 months, while median OS was not reached. Older patients showed longer PFS than younger patients (33.0 vs. 15.1 months; p = 0.13). EGFR or ALK alterations were associated with significantly shorter PFS (8.33 vs. 39.65 months; p = 0.009). Morning initiation of durvalumab was associated with numerically longer PFS than afternoon administration (39.65 vs. 16.38 months; p = 0.34). Multivariable analysis identified mutation status as independently associated with PFS, with no significant predictors for OS. Grade 3-5 adverse events occurred in 5.1% of patients, and treatment discontinuation was reported in 8.9%.

Conclusion: In this real-world cohort, consolidation durvalumab showed encouraging clinical outcomes with acceptable safety in patients with unresectable stage III NSCLC.