Durvalumab was found to prolong overall survival (OS) in patients with unresectable, stage III non-small cell lung cancer (NSCLC) with at least 50% programmed death ligand 1 (PD-L1) expression after concurrent chemoradiotherapy, according to a study presented at the 2020 World Conference on Lung Cancer in Singapore.1
Although durvalumab became available in British Columbia in early 2018, only approximately 50% of potentially eligible patients receive the treatment. The aim of this study was to evaluate patient outcomes with durvalumab in a real-world population.
The retrospective chart review analyzed data from 196 patients with unresectable, stage III NSCLC from all sites treated between 2018 and 2019 in British Columbia with concurrent chemoradiotherapy. Within the cohort, 97 patients received durvalumab and 99 patients were under surveillance.
At baseline, the median age was 67, 51% of patients were men, and 89% were current or former smokers. Among the patients with known PD-L1 status, 17% had expression <1%, 13% had expression between 1% and 49%, and 23% had expression 50% or greater.
The researchers found OS to be significantly longer with durvalumab among patients with at least 50% PD-L1 expression. The 1-year OS was 95% with durvalumab compared with 72% with surveillance among patients with PD-L1 expression of 50% or greater (P =.039).
Although not significant, there was a trend toward OS benefit with durvalumab among patients with low or no PD-L1 expression. The 1-year OS with durvalumab vs surveillance was 65% and 47%, respectively, among patients with less than 1% expression (P =.345) and 53% and 49%, respectively, among patients with 1% to 49% expression (P =.392).
The researchers also found OS to be longer among patients with unknown PD-L1 expression, which was 46% of patients in the cohort. Among these patients, the 1-year OS was 88% with durvalumab compared with 76% with surveillance (P =.023).
Durvalumab was considered to be well tolerated, with 11% of patients experiencing a grade 3 adverse event (AE) and no reports of grade 4 or 5 AEs. The most common AEs of any grade were pneumonitis and hypothyroidism.
The authors concluded that “based on these findings, PD-L1 expression may be a useful biomarker to predict efficacy, and patients should not be excluded from receiving durvalumab after chemoradiotherapy based on PD-L1 status.”
Kuang S, Liu M, Ho C, et al. Overall survival by PD-L1 status in stage III NSCLC following implementation of durvalumab: the real-world application of PACIFIC. Presented at: 2020 World Conference on Lung Cancer Singapore; January 28-31, 2020.