Durvalumab After Chemoradiotherapy in Unresectable NSCLC: Real-World Use and Outcomes

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In a U.S. retrospective cohort study (SPOTLIGHT) reported in JAMA Network Open, Mooradian et al found that a substantial proportion of patients with unresectable stage III non–small cell lung cancer (NSCLC) did not receive consolidation durvalumab after chemoradiotherapy—but those who did had markedly better outcomes.

As stated by the investigators, “The PACIFIC trial established consolidation durvalumab as the standard of care following [chemoradiotherapy] for patients with unresectable stage III NSCLC. Understanding its benefit in routine U.S. clinical practice is critical.”

Study Details

The study used patient-level data from the U.S. Flatiron Health database on patients who started durvalumab after chemoradiotherapy (durvalumab cohort, n = 332) or ended chemoradiotherapy without durvalumab (nondurvalumab cohort, n = 137) by the end of June 2019.

Key Findings

Median time to first subsequent therapy or death was not reached in the durvalumab cohort vs 8.3 months in the nondurvalumab cohort. Median time to distant metastasis or death was not reached vs 11.3 months.

Median progression-free survival was 17.5 months (95% confidence interval [CI] = 13.6–24.8 months) vs 7.6 months (95% CI = 5.2–9.8 months), with 24-month rates of 44.4% vs 8.8%, respectively. Median overall survival was not reached vs 19.4 months (95% CI = 11.7–24.0 months), with 24-month rates of 71.5% vs 41.0%, respectively.

In an analysis of patients who completed chemoradiotherapy without disease progression that adjusted for prior platinum agent receipt and patient characteristics, the use of durvalumab was associated with significantly better progression-free survival (hazard ratio [HR] = 0.36, 95% CI = 0.26–0.51) and overall survival (HR = 0.27, 95% CI = 0.16–0.43).  

The investigators concluded, “In this cohort study, findings were consistent with PACIFIC, and durvalumab was associated with a lower risk of [disease] progression and/or death. Further investigation is warranted to explain why patients did not receive durvalumab after its approval.”

Meghan J. Mooradian, MD, of the Division of Hematology Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, is the corresponding author for the JAMA Network Open article.

Disclosure: The study was sponsored by AstraZeneca. For full disclosures of the study authors, visit

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