Real-World Efficacy and Safety of Durvalumab Administration Following Chemoradiotherapy in Elderly Patients with Unresectable Locally Advanced Non-Small Cell Lung Cancer: A Multicenter, Retrospective Study

Abstract

BACKGROUNDThe PACIFIC trial established durvalumab administration after chemoradiotherapy as the standard of care for unresectable locally advanced non-small cell lung cancer (LA-NSCLC). However, the efficacy and safety of durvalumab in elderly patients aged 75 years or above remains unclear. This study aimed to investigate the real-world efficacy and safety of durvalumab for LA-NSCLC, with a specific focus on elderly patients. PATIENTS & METHODS: We reviewed 214 patients who received durvalumab out of 278 patients with unresectable LA-NSCLC who underwent chemoradiotherapy at seven institutions between July 2018 and March 2022. Propensity score matching (PSM) analysis was performed to evaluate the efficacy of durvalumab in elderly patients. RESULTS: The 2-year progression-free survival (PFS) and 2-year overall survival (OS) rates were 42.2% [95% confidence interval (CI): 34.7-49.5%] and 77.1% (95% CI: 70.1-82.7%), respectively. Grade ≥3 immune-related adverse events (irAEs) occurred in 8.2% of patients. PSM analysis revealed that OS was significantly shorter in elderly patients (≥75 years) than in younger patients (<75 years) [hazard ratio (HR); 95% CI: 1.39-8.99; P=0.008], whereas PFS did not differ significantly between the two groups (HR: 1.50, 95% CI: 0.84-2.68, P=0.169). The frequency of irAEs did not differ between these groups. CONCLUSIONS: The real-world efficacy and safety of durvalumab administration following chemoradiotherapy for LA-NSCLC coincided with the PACIFIC trial's findings. Disease control achieved with this protocol did not differ significantly between elderly and younger patients but had acceptable tolerability, demonstrating its benefit even in elderly LA-NSCLC patients aged 75 years or above.