Immunotherapy has emerged as an important treatment modality throughout oncology with a particularly important role in the treatment of lung cancer. Early signals showed responses could be achieved in nonsmall cell lung cancer and small cell lung cancer and these monoclonal antibodies have become standards of care for advanced stage disease. They have also shown promise in earlier‐stage disease as complements to radiation or surgery, offering the potential for durable, meaningful survival gains.

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Introduction:The PACIFIC trial showed survival benefit of consolidation durvalumab after concurrent chemoradiation (CRT) in stage III unresectable non-small cell lung cancer (uNSCLC). However, only 41% of placebo-assigned patients in this trial who had post-progression treatment received immune checkpoint inhibitor (ICI). We aimed to evaluate the survival outcomes and exposure to subsequent ICI among patients who did and did not receive durvalumab consolidation in the real-world setting. Methods: Electronic medical records at Roswell Park were retrospectively reviewed to identify unresectable stage III NSCLC patients with no prior ICI who received 54-66Gy thoracic RT and either concurrent or sequential chemotherapy between 1/2015-6/2019. 45 uNSCLC patients met eligibility criteria. Patients were categorized by treatment received after CRT: durvalumab consolidation (D) or no durvalumab consolidation (ND). Subsequent ICI administration upon disease progression among ND (ND-PD) was evaluated. Covariates of interest in survival analyses included age, smoking status, histology, PDL1 expression, and the presence of KRAS mutation. Kaplan-Meier survival curve and Cox Proportional Hazard model were utilized to analyze progression-free survival (PFS) and overall survival (OS). Results: Demographics and survival outcomes are shown in the table. Majority (75%) of ND-PD patients received ICI. Multivariate analysis of OS with adjusted covariates showed trend toward better OS with D compared to ND but not statistically significant (p¼0.21). Similarly, PFS trended better for D (p¼0.19). Age <70 years was associated with worse PFS (p¼0.029) and unknown KRAS status had better PFS (p¼0.02), but both of these variables did not affect OS. All other covariates did not significantly influence survival outcomes.Conclusion: 75% of ND received subsequent ICI upon PD. No statistically significant differences in OS and PFS were observed between D and ND, though the trend favored D.

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