WCLC 2025 - Posters & ePosters-PT1.08.03 Chemoradiation/Immunotherapy(IO) for Stageiii NSCLC: Timing of IO, and the Benefits/Selection in Elderly & Black Patients

PT1.08.03 Chemoradiation/Immunotherapy(IO) for Stageiii NSCLC: Timing of IO, and the Benefits/Selection in Elderly & Black Patients

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This study evaluates the use, timing, and benefits of immunotherapy (IO), specifically durvalumab consolidation after concurrent chemoradiation therapy (CRT), in stage III non-small cell lung cancer (NSCLC) patients from 2016 to 2021. Durvalumab received FDA approval in 2018 for this indication. Using data from the National Cancer Database (NCDB), 15,601 patients receiving CRT with or without IO were analyzed, focusing on overall survival (OS), IO usage trends, and patient subgroups, including elderly and racial minorities.<br /><br />Key findings include increasing IO utilization from 51.8% in 2018 to 62.7% in 2021, despite underuse relative to guidelines. IO provided a significant OS benefit regardless of the timing of initiation after CRT; hazard ratios for OS ranged from 0.56 to 0.64 depending on initiation timing (0-14, 15-28, 29-42, and >42 days post-CRT), with median OS between 39.2 and 42.8 months. Notably, many patients started IO later than the 42-day window permitted by the pivotal PACIFIC trial (median 61 days), yet still benefited.<br /><br />Subgroup analyses revealed that elderly patients (≥70 years) experienced survival benefits from IO comparable to younger patients. Black and White Hispanic patients showed greater survival improvements with IO compared to White non-Hispanic patients, although these minority groups received IO significantly less often. Factors associated with lower IO use included older age, minority race (Black/White Hispanic), higher comorbidity scores, and treatment in less educated counties.<br /><br />Multivariable analysis identified different favorable OS factors before and after IO approval. In 2018-2021, non-squamous histology, younger age, lower Charlson-Deyo comorbidity index, smaller tumor size, Black race, and care at academic centers correlated with better OS.<br /><br />In conclusion, consolidative IO after CRT improves survival across age and racial groups in stage III NSCLC but remains underutilized, particularly among elderly and minority populations. Increasing equitable IO access is critical to improving outcomes in these underserved groups.

Asset Subtitle

John Varlotto

Meta Tag

Speaker John Varlotto

Topic Local-Regional Non-small Cell Lung Cancer

Keywords

immunotherapy

durvalumab

concurrent chemoradiation therapy

stage III non-small cell lung cancer

overall survival

National Cancer Database

elderly patients

racial minorities

FDA approval 2018

healthcare disparities