KEY POINTS
- This retrospective observational study included 656 consecutive patients with unresectable stage III NSCLC treated with radical radiotherapy in the West of Scotland between 2017 and 2022; 62% lived in the two most deprived socioeconomic quintiles.
- Treatment comprised radiotherapy alone in 59%, sequential chemoradiotherapy in 9%, concurrent chemoradiotherapy in 22%, and concurrent chemoradiotherapy followed by durvalumab in 11%.
- In the adjusted survival cohort of 372 patients, durvalumab after concurrent chemoradiotherapy improved 2-year progression-free survival versus concurrent chemoradiotherapy alone (HR 0.51, 95% CI 0.33–0.78; p=0.002). Two-year progression-free rates were 64% versus 39%.
- Two-year overall survival did not differ significantly between concurrent chemoradiotherapy with and without durvalumab (HR 0.87; p=0.54). Radiotherapy alone was associated with worse overall survival (HR 2.36, 95% CI 1.66–3.40; p<0.001).
- Only 31 of 69 patients (45%) completed 12 months of durvalumab. Treatment-related adverse events occurred in 54%, and pneumonitis caused discontinuation in 9 patients.
CLINICAL TAKEAWAY
These findings support the real-world effectiveness of consolidation durvalumab after concurrent chemoradiotherapy, including in patients with substantial socioeconomic deprivation and multimorbidity. However, the retrospective non-randomized design, baseline treatment-selection differences, and limited follow-up prevent causal conclusions. The persistently high use of radiotherapy alone, despite poor outcomes, identifies an important population needing better fitness assessment and alternative systemic-treatment strategies.