Real World Outcomes versus Clinical Trial Results of Durvalumab Maintenance in Veterans with Stage III Non-Small Cell Lung Cancer

Kamya Sankar, Alex K. Bryant, Garth W. Strohbehn, Lili Zhao, David Elliott, Drew Moghanaki, Michael J. Kelley, Nithya Ramnath*, Michael D. Green*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

One year of durvalumab following concurrent chemoradiotherapy improves progressionfree (PFS) and overall survival (OS) for patients with stage III non-small cell lung cancer (NSCLC). However, the real-world efficacy of durvalumab has not been determined. We conducted a multicenter observational cohort study across the Veterans Health Administration, including patients with stage III NSCLC who received concurrent chemoradiotherapy and durvalumab, compared to patients who received concurrent chemoradiotherapy alone. Kaplan–Meier and Cox regression approaches were used to identify factors associated with PFS and OS. We calculated a hazard ratio and efficacyeffectiveness factor to compare OS of veterans to the referenced clinical trial population. A total of 1006 patients with stage III NSCLC who received concurrent chemoradiotherapy and at least one dose of durvalumab from November 2017 to April 2021 were compared to 989 patients who received concurrent chemoradiotherapy alone from January 2015 to December 2016. Adjuvant durvalumab was associated with higher PFS (HR 0.62, 95% CI 0.55–0.70, p < 0.001) and OS (HR 0.57, 95% CI 0.50–0.66, p < 0.001). OS was shorter in veterans compared to PACIFIC (HR 1.24, 95% CI 1.03–1.48, p = 0.02: EE gap 0.73). OS of veterans with stage III NSCLC treated with adjuvant durvalumab is improved compared to a modern comparator but is reduced compared to the PACIFIC population.

Original languageEnglish (US)
Article number614
JournalCancers
Volume14
Issue number3
DOIs
StatePublished - Feb 1 2022

Keywords

  • Durvalumab
  • Efficacy-effectiveness gap
  • Immunotherapy duration
  • Stage III non-small cell lung cancer
  • Veteran population

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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