Adjuvant durvalumab after concurrent chemoradiotherapy for patients with unresectable stage III NSCLC harboring uncommon genomic alterations
Menée auprès de 271 patients atteints d'un cancer du poumon non à petites cellules de stade III non résécable traité entre 2016 et 2022, cette étude internationale évalue l'efficacité, du point de vue de la survie sans progression, de l'ajout de durvalumab à une chimioradiothérapie chez des patients présentant des mutations "conductrices" peu fréquentes
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 is lacking about patients harbouring other driver genomic alterations (dGA). We performed a multicenter (N=4, Netherlands and Italy) retrospective study including consecutive patients with unresectable stage III NSCLC, 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, 21 uncommon dGA). In the entire population, 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.