Adjuvant durvalumab after concurrent chemoradiotherapy for patients with unresectable stage III NSCLC harbouring uncommon genomic alterations. (May 2023)

• Record Type: Journal Article
• Authors: Cortiula, Francesco; De Ruysscher, Dirk; Steens, Michelle; Wijsman, Robin; van der Wekken, Anthonie; Alberti, Martina; Hendriks, Lizza E.L.
• Is Part Of: European journal of cancer. Volume 184(2023)
• Page Start: 172
• Page End: 178
• Publication Date: 2023-05
• Subjects: Stage III NSCLC -- Unresectable NSCLC -- Driver genomic alterations -- KRAS mutation -- Uncommon driver genomic alterations -- Adjuvant immunotherapy -- Progression-free survival; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2023.02.013
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Adjuvant durvalumab is the standard of care for patients with stage III unresectable non-small cell lung cancer (NSCLC), without progression after concurrent chemo-radiation (CCRT). Patients with stage III NSCLC harbouring epidermal growth factor receptor ( EGFR ) mutations and anaplastic lymphoma kinase rearrangements do not seem to benefit from durvalumab. Data are lacking about patients harbouring other driver genomic alterations (dGA). We performed a multicentre (N = 4, Netherlands and Italy) retrospective study including consecutive patients with unresectable stage III NSCLC and treated with CCRT—with or without adjuvant durvalumab—between 2016 and 2022. We enrolled 271 patients; 130 of which received adjuvant durvalumab. Sixty-six patients had dGA (41 KRAS mutations, 4 EGFR common mutations and 21 uncommon dGA). In the entire population, the median PFS was 24.9 months (95% CI 17.5–32.4) and 12.6 months (95% CI 9.0–16.1) with and without durvalumab (p = 0.001). In the dGA group (excluding common EGFR), mPFS was 12.3 months (95% CI 7.8–16.8) with and 7.6 (95% CI 3.4–11.9) without durvalumab (p = 0.038). For patients with KRAS mutations, mPFS was 12.3 months (95% CI 3.6–20.9) with and 7.2 months (95% CI 1.8–12.6) without durvalumab (p = 0.12). Among patients with uncommon dGA, mPFS was 12.9 months (95% CI 8.4–17.4) with and 7.6 months (95% CI 1.4–14) without durvalumab (p = 0.23). We have shown a meaningful survival benefit of adjuvant durvalumab in patients harbouring KRAS mutations and uncommon dGA. This is the largest stage III NSCLC cohort showing the efficacy of durvalumab in patients with uncommon dGA. Further prospective studies are needed to confirm our results. Highlights: Largest cohort of patients with stage III NSCLC and uncommon genomic alterations. Adjuvant durvalumab improved survival in patients with uncommon genomic alterations. Adjuvant durvalumab improved survival in patients with KRAS mutations. Molecular testing should be mandatory for patients with stage III NSCLC. Clinical trials should investigate the best adjuvant treatment in this setting.