Treating patients who have stage III non–small cell lung cancer (NSCLC) with durvalumab concurrently with chemoradiotherapy (CRT) and continuing as consolidation therapy did not improve overall survival (OS) compared with consolidation therapy with durvalumab alone, according to research presented at the International Association for the Study of Lung Cancer (IASLC) 2025 World Conference on Lung Cancer (WCLC; Abstract PL03.04).
Consolidation therapy with durvalumab has improved survival for patients with unresectable stage III NSCLC after definitive CRT. However, the optimal timing of initiation of immune checkpoint inhibition is unknown. The phase III EA5181 trial tested the hypothesis that starting durvalumab concurrently with CRT and continuing as consolidation would improve OS compared with consolidation therapy with durvalumab alone.
The trial enrolled 662 patients with previously untreated, unresectable stage IIIA–C NSCLC or with mediastinal node recurrence after prior surgery. Patients were randomly assigned to receive either concurrent therapy with durvalumab plus chemotherapy and radiotherapy (arm A) or CRT alone (arm B). Patients in both arms who completed CRT without disease progression or significant toxicity were assigned to 1 year of durvalumab consolidation therapy.
Results showed a median OS of 41.5 months in arm A vs 39.4 months in arm B (P = .83, hazard ratio [HR] = 1.03). Median progression-free survival was 15.5 vs 16.8 months (P = .65, HR = 1.05).
There were no significant differences reported in objective response rate, patterns of failure, or toxicity between the arms.
“Our study found that adding durvalumab concurrently with chemoradiotherapy did not improve overall survival compared to starting durvalumab as consolidation alone,” said John Varlotto, MD, of Marshall University in Huntington, West Virginia. “These findings suggest that the current standard of initiating durvalumab after CRT remains appropriate for unresectable stage III NSCLC.”
Dr. Varlotto pointed out that the study found Eastern Cooperative Oncology Group performance status, adenocarcinoma histology, and a carbon monoxide diffusing score of more than 80% were associated with significantly better outcomes, whereas prior thoracic surgery was linked to better progression-free survival.
Disclosure: For full disclosures of the study authors, visit cattendee.abstractsonline.com.
