Efficacy of immune drugs in maintenance therapy after radical chemoradiation treatment of lung cancer: Results of real clinical practice

Introduction. Durvalumab is the first immunotherapy drug proven effective as consolidation therapy after chemoradiotherapy (CRT) in patients with unresectable stage III non-small cell lung cancer (NSCLC). The PACIFIC and PACIFIC-R trials confirmed significant survival benefits, but real-world data, including from Russian studies, show variability in outcomes.

Aim. To evaluate the effectiveness of durvalumab in real-world clinical practice in patients with stage IB-IIIC NSCLC after definitive CRT.

Materials and methods. A retrospective analysis of 81 patients (2021–2024) who received durvalumab after CRT (60 Gy ± 10%). Median age was 63 years; 78% were smokers. Histology: 75% squamous cell carcinoma, 23% adenocarcinoma. PD-L1 status: 22% ≥ 1%, 18% unknown. Progression-free survival (PFS) and overall survival (OS) were assessed using the Kaplan–Meier method.

Results. Median PFS was 14 months (95% CI: 12–22); OS at 28 months was 52%. Better PFS in squamous cell carcinoma (19 vs. 13 months in adenocarcinoma), but not statistically significant (p = 0.08). Significant PFS improvement in PD-L1+ (HR = 0.43; p = 0.025), but not OS (p = 0.053). Higher PFS in stages I–IIIA (22 vs. 12 months in IIIB-IV; p = 0.01), but no OS difference. Grade 3–4 adverse events in 15% (pneumonitis – 4.9%).

Conclusion. Durvalumab demonstrates clinically meaningful PFS improvement, especially in PD-L1+ patients and early-stage disease. However, its impact on OS requires further follow-up. Results align with PACIFIC but highlight the importance of individual factors (histology, PD-L1, stage).

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