Durvalumab consolidation after chemoradiotherapy in elderly patients with unresectable stage III NSCLC: A real-world multicenter study

Background The PACIFIC trial demonstrated survival benefit of durvalumab after concurrent chemoradiotherapy (CCRT) in unresectable stage III non-small-cell lung cancer. Data on the effectiveness and safety of durvalumab in elderly patients is lacking. Methods This retrospective study was conducted between September 2017 and September 2022. Progression-free survival (PFS), overall survival (OS), recurrence patterns, first subsequent treatment after recurrence, factors associated with survival outcomes, and adverse events (AEs) were compared. Results Of the 286 patients, 120 (42.0%) were ≥70 years and 166 (58.0%) were <70 years. The median PFS (17.7 vs. 19.4 months; p = 0.43) and median OS (35.7 months vs. not reached; p = 0.13) were similar between two groups. Proportion of patients who completed durvalumab was lower in elderly patients (27.5% vs. 39.2%; p = 0.040). In elderly patients, ECOG PS 0 or 1 was associated with better PFS, and being male and having received a cisplatin-based regimen during CCRT were factors associated with better and worse OS, respectively. In patients aged <70 years, a PD-L1 ≥50% was associated with improved PFS and OS. Elderly patients experienced more treatment-related AEs, grade 3/4 AEs, permanent discontinuation of durvalumab, and treatment-related deaths. Among the AEs leading to permanent discontinuation or death, pulmonary AE was significantly more common in elderly patients. Conclusion Durvalumab demonstrated similar outcomes in elderly compared to younger patients. However, AEs were more common in elderly patients. Thus, judicious selection of patients and chemotherapy regimens, coupled with careful AE monitoring, are important factors for ensuring optimal durvalumab treatment.