Durvalumab after chemoradiotherapy for locoregional recurrence of completely resected non-small-cell lung cancer (NEJ056)

Abstract

Locoregional recurrence of non-small-cell lung cancer (NSCLC) after complete resection lacks standard treatment. Durvalumab after chemoradiotherapy (CRT) or CRT alone is often selected in daily clinical practice for patients with locoregional recurrence; however, the therapeutic efficacy of these treatments remains unclear, and we aimed to assess this. This retrospective observational study used data from patients with NSCLC diagnosed with locoregional recurrence after complete resection who subsequently underwent concurrent CRT followed by durvalumab (CRT-D group) or CRT alone (CRT group). We employed propensity score analysis with inverse probability treatment weighting (IPTW) to adjust for various confounders and evaluate efficacy in the CRT-D group. After IPTW adjustment, the CRT-D group contained 119 patients (64.7% male; 69.7% adenocarcinoma), and the CRT group contained 111 patients (60.5% male; 73.4% adenocarcinoma). Their mean ages were 66 and 65 years, respectively. The IPTW-adjusted median progression-free survival was 25.4 and 11.5 months for the CRT-D and CRT groups, respectively (hazard ratio, 0.44; 95% confidence interval, 0.30-0.64); the median overall survival was not reached in either group favoring CRT-D (hazard ratio, 0.49; 95% confidence interval, 0.24-0.99). Grade 3 or 4 adverse events were observed in 48.8% of patients during CRT, 10.7% after initiating durvalumab maintenance therapy in the CRT-D group, and 57.3% in the CRT group. Overall, the sequential approach of CRT followed by durvalumab is a promising treatment strategy for locoregional recurrence of NSCLC after complete resection.

Keywords: chemoradiotherapy; durvalumab; inverse probability treatment weighting; locoregional recurrence; non–small‐cell lung cancer.

FIGURE 1

Patient flowchart. CRT, chemoradiotherapy alone; CRT‐D, concurrent CRT followed by durvalumab; IPTW, inverse probability treatment weighting.

FIGURE 2

IPTW‐adjusted Kaplan–Meier curves and estimated median progression‐free survival (A) and overall survival (B) in the CRT‐D and CRT groups. CI, confidence interval; CRT, chemoradiotherapy alone group; CRT‐D, concurrent CRT followed by durvalumab group; HR, hazard ratio; PTW, inverse probability treatment weighting; KM, Kaplan–Meier; NA, not assessed; OS, overall survival; PFS, progression‐free survival.

FIGURE 3

Subgroup analysis of prognostic factors for IPTW‐adjusted progression‐free survival. CI, confidence interval; CRT, chemoradiotherapy alone group; CRT‐D, concurrent CRT followed by durvalumab group; HR, hazard ratio; IPTW, inverse probability treatment weighting; PD‐L1, programmed cell death ligand 1.

FIGURE 4

IPTW‐adjusted progression‐free survival (A) and overall survival (B) from the start of durvalumab in the CRT‐D group. CI, confidence interval; CRT‐D, concurrent CRT followed by durvalumab group; HR, hazard ratio; IPTW, inverse probability treatment weighting; KM, Kaplan–Meier; NA, not assessed; OS, overall survival; PFS, progression‐free survival.