Real world evidence supports the effectiveness and safety of consolidation durvalumab following chemoradiotherapy for older patients with unresectable stage 3 NSCLC deemed fit enough for treatment.

A retrospective Australian study comprised 152 patients from seven sites in Sydney and treated with at least one cycle of the PD-L1 blocking immunotherapy between 2018 and 2021. The median age of patients was 67 years with 43% over 70 years old.

The study, published in the Journal of Geriatric Oncology [link here], found the median overall survival (OS) was not reached. Two-year OS was 70.6% overall, 74.8% in patients <70 years old, and 65.2% in patients ≥70 years old (p = 0.07; hazard ratio [HR] 1.64.)

Median progression-free survival (PFS) in the overall population was 30.3 months, 30.3 months as well amongst patients <70 years old, and 26.7 months in patients ≥70 years old (p = 0.22; HR 1.46).

Toxicity during durvalumab consolidation was common in all patients with 77% having any adverse event but only 14.5% having a grade 3-4 event. There were no statistically significant differences in toxicity between older and younger patients.

On multivariable analysis, only a CCI score ≥ 5 was associated with a higher incidence of grade 3–4 toxicity from durvalumab (p = 0.022).

About half (55.3%) of patients experienced immune-related adverse events such as pneumonitis (27.6%), dermatitis (23.7%), and thyroid dysfunction (17.1%).

The study also found age did not influence the frequency of second systemic therapy in patients who had relapsed (p = 0.44).

The investigators, led by Dr Samuel Stevens from Concord Repatriation General Hospital, Sydney, said the findings helped fill an evidence gap as older patients were underrepresented in the PACIFIC trial [link here].

“In keeping with the findings of PACIFIC and PACIFIC-R, we observed statistically comparable but numerically poorer survival outcomes in older patients receiving this regimen,” they said.

“Toxicities were similar between age groups. However, both survival outcomes and toxicity appeared more strongly associated with comorbidities than age.”

They said high rates of frailty have been observed in patients with NSCLC and may provide the most complete explanation for poorer survival outcomes in older patients with cancer.

“Whilst not yet widely adopted, frailty screening and assessment has been associated with reduced treatment toxicity, improved quality of life, and improved care delivery for older patients with cancer.”

“The increasing recognition of frailty as a prognostic entity in NSCLC should prompt clinicians to undertake additional assessment when determining appropriate treatment for older patients in future,” they concluded.