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Publications

Journal Article Review Epublish

PubMed: 40075721 DOI: 10.3390/cancers17050874

Real-World Insights into the Impact of Durvalumab on Stage III Unresectable Non-Small Cell Lung Cancer-A Narrative Review.

Cancers (Basel) 17(5)

Authors: Giorgio Facheris, Gianluca Cossali, Jessica Imbrescia, Salvatore La Mattina, Eneida Mataj, Nicole Meli, Giulia Volpi, Luca Triggiani, Andrea Emanuele Guerini, Guido Levi, Salvatore Grisanti, Michela Buglione di Monale E Bastia, Paolo Borghetti

Affiliations

  • Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy.
  • Radiation Oncology Unit, Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy.
  • Departement of Radiation Oncology, San Matteo Hospital Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 27100 Pavia, Italy.
  • Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, 25123 Brescia, Italy.
  • Azienda Ospedaliera Universitaria Integrata Verona, Radiation Oncology, 37126 Verona, Italy.
  • Pulmonology Department, ASST Spedali Civili di Brescia, 25123 Brescia, Italy.
  • Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy.

Abstract

INTRODUCTION AND AIM

Stage III Non-Small Cell Lung Cancer (NSCLC) has a poor prognosis, with median survival ranging from 9 to 34 months. The PACIFIC trial demonstrated that durvalumab after platinum-based chemoradiotherapy (CRT) improves overall survival (OS) and progression-free survival (PFS). This review evaluates real-world evidence (RWE) on durvalumab's efficacy and safety, focusing on patient characteristics, prognostic factors, treatment protocols, and outcomes beyond progression.

MATERIALS AND METHODS

A literature search of PubMed, Embase, and Google Scholar identified 49 observational studies published from January 2017 to August 2024 on unresectable stage III NSCLC. Clinical trials, early-stage disease, and alternative treatments were excluded.

RESULTS

Compared to the PACIFIC trial, real-world patients were older, had poorer ECOG performance (≥2), and more comorbidities like COPD. Despite this, durvalumab provided consistent survival benefits. Positive prognostic factors included non-squamous histology, high PD-L1 expression, and timely durvalumab initiation (≤42 days post-CRT). Most radiotherapy regimens mirrored PACIFIC (54-66 Gy). Concomitant CRT was used in 90% of cases, with sequential CRT for frail patients. Chemotherapy regimens varied. Immune-mediated pneumonitis was a major adverse event, with incidence rates between 15% and 100%. Severe cases led to treatment discontinuation, impacting survival. Treatment beyond progression remains uncertain, with limited benefits from immunotherapy rechallenge.

CONCLUSIONS

RWE supports durvalumab's efficacy, emphasizing the need for personalized treatment strategies and further research to improve long-term outcomes.

MeSH

Radiotherapy, Cells, Lung, Neoplasms, Carcinoma, Non-Small-Cell Lung, Drug Therapy, Immunotherapy, Lung Neoplasms, Small Cell Lung Carcinoma, Therapeutics, Prognosis, Chemotherapy