Brief report: Impact of consolidation durvalumab on unresectable non-small lung cancer with driver mutations.

Abstract

Unresectable stage III non-small cell lung cancer (NSCLC) carries a poor prognosis. The PACIFIC trial established consolidation durvalumab after chemoradiation as a standard treatment; however, its efficacy in patients with driver mutations remains uncertain. This retrospective cohort study analyzed data from three oncology centers in Hong Kong, covering the period from January 2019 to December 2022. Among the 118 patients who underwent definitive chemoradiation, 33 had common driver mutations, including EGFR mutations, ALK rearrangements, ROS1 rearrangements, and RET fusions. The addition of durvalumab did not improve real-world recurrence-free survival (rwRFS) in patients with these mutations (hazard ratio [HR] 0.852, 95 % confidence interval [CI] 0.394 - 1.843, p= 0.683). In contrast, rwRFS significantly improved for patients without common mutations (HR 0.342, 95 % CI 0.203 - 0.577, p< 0.001). These findings suggest that consolidation durvalumab may not be beneficial for patients with common driver mutations, underscoring the need for personalized treatment strategies in this population.