Clinical management and outcomes of relapsed NSCLC after chemoradiotherapy and durvalumab consolidation: real-world evidence from Germany.

BACKGROUND

Despite recent advances in the treatment of locally advanced non-small cell lung cancer (NSCLC), most patients relapse after definitive chemoradiotherapy followed by durvalumab consolidation. Due to limited evidence on post-relapse management, no standard treatment approach has been established for this patient population.

OBJECTIVES

The objective of this study was to evaluate real-world treatment strategies and clinical outcomes in patients with NSCLC who experienced disease recurrence after durvalumab consolidation.

DESIGN

This was a multicenter, retrospective cohort study conducted across 12 German lung cancer centers.

METHODS

A total of 145 patients with recurrent NSCLC following chemoradiotherapy and durvalumab consolidation were analyzed. Clinical, pathological, and treatment-related data were collected, including smoking status, histology, molecular testing, therapeutic sequences, and survival outcomes. Overall survival (OS) and progression-free survival (PFS) were estimated and compared across subgroups according to relapse characteristics and post-relapse treatment strategies. Multivariate analyses were performed to identify independent prognostic factors.

RESULTS

The median OS from initial diagnosis was 27.1 months (95% confidence interval (CI): 22.5-31.8). After relapse, median OS was 12.2 months (95% CI: 9.9-14.4), and median PFS was 7.1 months (95% CI: 5.7-8.4). Approximately 70% of patients received systemic therapy after relapse, including platinum-based chemotherapy (18.6%), single-agent chemotherapy (18.6%), immune checkpoint inhibitors with or without chemotherapy (28.3%), and targeted therapy (4.8%). Patients treated with immune checkpoint inhibitors or targeted therapies showed a numerical improvement in OS compared with chemotherapy alone, although this difference did not reach statistical significance. Multivariate analysis identified first-line post-relapse treatment, Eastern Cooperative Oncology Group performance status, and histologic subtype as independent prognostic factors for OS.

CONCLUSION

Patients with relapsed NSCLC after durvalumab consolidation have a poor prognosis and remain a therapeutically underserved population. Clinical outcomes appear to be influenced by performance status, histology, and the choice of post-relapse therapy. Prospective clinical trials are urgently needed to define optimal treatment strategies for these patients.