Investigation of non-completion factors for durvalumab maintenance therapy in locally advanced non-small cell lung cancer.

Background: The phase III PACIFIC trial demonstrated that one year of durvalumab maintenance therapy after concurrent chemoradiotherapy (CCRT) significantly improved overall survival (OS) in unresectable stage III non-small cell lung cancer (NSCLC), reducing the risk of death by 32% compared with observation. Durvalumab therapy administered for up to 12 months is currently the standard of care for patients with locally advanced NSCLC. This study aimed to identify the factors influencing the completion of durvalumab therapy. Methods: This retrospective study analyzed patients who initiated durvalumab therapy for unresectable NSCLC at Niigata University Medical and Dental Hospital between August 2018 and December 2022. Patients who discontinued the treatment for reasons unrelated to disease progression or adverse events were excluded. The patients were divided into durvalumab completion and non-completion groups, and the clinical factors influencing durvalumab completion were analyzed. Results: Among the 65 enrolled patients, 46.2% completed one year of durvalumab maintenance therapy. The completion rate was significantly lower in patients who received low-dose carboplatin as part of CCRT (20% Conclusions: Low-dose carboplatin CCRT is associated with lower durvalumab completion rates and worse outcomes, particularly in older patients. Alternative CCRT regimens may warrant consideration, particularly for older patients who are less likely to complete durvalumab maintenance.