Durvalumab Consolidation After Chemoradiotherapy in Unresectable Stage III Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis of Efficacy and Safety.

Abstract

Objectives: Durvalumab consolidation following concurrent chemoradiotherapy (CRT) has become the standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC). However, survival outcomes reported in clinical trials and real-world studies have been inconsistent, making it difficult to understand the efficacy and safety of this treatment modality fully. Our study aims to pool the available evidence to evaluate the impact of durvalumab in patients with unresectable stage III NSCLC.

Methods: PubMed, Embase, Cochrane Library, and Web of Science were searched for studies including randomized controlled trials and real-world observational studies that assess durvalumab after definitive CRT in unresectable stage III NSCLC, till January 2026. Data extracted included median overall survival (OS), median progression-free survival (PFS), and survival rates. Random-effects meta-analyses were performed to pool OS and PFS.

Results: A total of 3 studies comprising 861 patients with unresectable stage III NSCLC were included. Durvalumab consolidation after definitive CRT showed no statistically significant effect on OS (HR: 1.06, 95% CI: 0.52-2.14; I ²=51.6%; P =0.1268) or PFS (HR: 0.87, 95% CI: 0.45-1.68; I ²=49.6%; P =0.1374). Heterogeneity was moderate for both outcomes. In addition to these primary outcomes, multiple secondary efficacy and safety outcomes were systematically evaluated, including overall response rate and treatment-related adverse effects.

Conclusions: Durvalumab consolidation demonstrates a favorable safety profile, but outcomes remain variable across studies. These findings highlight the importance of biomarker-driven patient selection and prospective real-world evaluation to maximize the clinical benefit of durvalumab in unresectable stage III NSCLC.