# Real-World Outcomes of Chemoradiotherapy in Patients with Stage II/III Non-Small-Cell Lung Cancer in the Durvalumab Era: An Observational Study

## TL;DR

This study confirms that durvalumab improves survival in real-world lung cancer patients after chemoradiotherapy, especially those in good health with few other illnesses.

## Contribution

The study provides real-world validation of durvalumab's effectiveness in stage III NSCLC patients beyond clinical trial settings.

## Key findings

- Patients receiving durvalumab after chemoradiotherapy had longer survival and slower disease progression.
- Good performance status and low comorbidity were strongly associated with better outcomes.
- Durvalumab's benefits were confirmed in a European cohort under routine clinical conditions.

## Abstract

Durvalumab is a drug used after chemoradiotherapy (CRT) to help the immune system fight lung cancer. While clinical trials like the PACIFIC study showed that this approach improves survival in patients with stage II/III non-small-cell lung cancer (NSCLC), it is unclear how well these results apply to everyday clinical practice. In our study, we looked at real-world outcomes in 72 patients treated at a single center in Germany. We found that patients who received durvalumab after CRT lived longer and had fewer disease progressions—especially those with good general health and few other illnesses. These findings confirm that durvalumab works well outside of clinical trials and highlight the importance of overall fitness and low comorbidity in lung cancer treatment.

Background: Consolidation therapy with durvalumab after definitive chemoradiotherapy (CRT) has become the standard care for patients with stage III non-small-cell lung cancer (NSCLC) following the PACIFIC trial. However, real-world data evaluating outcomes under routine clinical conditions remain limited, particularly in European cohorts. Methods: In this retrospective single-center study, we analyzed clinical data from 72 patients with stage III NSCLC treated with definitive CRT between 2017 and 2022. The patients were stratified by receipt of durvalumab consolidation. Univariable and multivariable Cox regression models were used to assess overall survival (OS) and progression-free survival (PFS). Stepwise variable selection based on the Akaike Information Criterion (AIC) was used to construct an optimized multivariable model. A sensitivity analysis with adjustment for treatment period (2017–2018 vs. 2019–2022) was conducted to account for the introduction of durvalumab into routine clinical practice. Results: Among 72 patients, 35 received durvalumab and 37 did not. The median OS was 2.08 years; the 3- and 5-year OS rates were 38.6% and 30.3%, respectively. Multivariable regression revealed significantly improved OS associated with Karnofsky performance status (KPS) > 80% (HR 0.29, p = 0.003), Charlson Comorbidity Index (CCI) ≤ 2 (HR 0.39, p = 0.009), and durvalumab treatment (HR 3.99, p = 0.008). PD-L1 expression ≥ 1% showed a trend toward improved OS (HR 3.72, p = 0.063). The median progression-free survival (PFS) for the total cohort was 1.17 years. The estimated 3- and 5-year PFS rates were 31.1% and 26.3%, respectively. Patients treated with durvalumab had a longer median PFS (20.5 months) compared to those without durvalumab (12.0 months). In the multivariable analysis, KPS > 80% (HR 0.29, p < 0.001), CCI ≤ 2 (HR 0.53, p = 0.048), and durvalumab treatment (HR 2.81, p = 0.023) were significantly associated with improved PFS. A sensitivity analysis adjusting for treatment period—reflecting the introduction of durvalumab into routine clinical practice from 2019—confirmed the robustness of these findings. Conclusions: Our findings support the clinical benefit of durvalumab consolidation following CRT in a real-world population, especially in patients with good performance status and low comorbidity burden. These results confirm and extend the PACIFIC trial findings into routine clinical practice, highlighting the prognostic value of functional status and comorbidity alongside PD-L1 expression.