Adjuvant Durvalumab Efficacy for Non-Small Cell Lung Cancer With Mutations

In a retrospective multicenter study adjuvant durvalumab significantly improved the survival of patients with stage 3 unresectable non-small cell lung cancer (NSCLC) with KRAS mutations, and uncommon driver genomic alterations who had previously undergone concurrent chemo-radiation without experiencing disease progression.

“In stage 3 NSCLC, data are lacking about the efficacy of adjuvant immunotherapy in patients harbouring other [driver genomic alterations], such as MET exon 14 skipping mutations, BRAF mutations and uncommon EGFR mutations,” explained Francesco Cortiula, MD, Department of Oncology, University Hospital of Udine, Udine, Italy, and colleagues.

The study enrolled a total of 271 consecutive patients with stage 3 NSCLC who underwent concurrent chemoradiation between 2016 and 2022, with 130 patients receiving adjuvant durvalumab. Among the enrolled patients, 66 had driver genomic alterations, including 41 KRAS mutations, 4 common EGFR mutations, and 21 uncommon driver genomic alterations. The primary objective was to assess the progression-free survival (PFS) in patients with and without adjuvant durvalumab.

The median PFS of all patients who received durvalumab was 24.9 months compared to 12.6 months in those patients who did not receive durvalumab (P = .001). In the subgroup of patients with driver genomic alterations (excluding common EGFR mutations), the median PFS was 12.3 months with durvalumab vs 7.6 months without (P = .038). More specifically, patients with KRAS mutations had a median PFS of 12.3 months with durvalumab vs 7.2 months without (P = .12), and patients with uncommon driver genomic alterations had a median PFS of 12.9 months with durvalumab compared to 7.6 months without (P = .23).

The authors stated this study enhanced the understanding of managing unresectable NSCLC cases with driver genomic alterations. They also “believe that molecular testing should be mandatory for all patie”ts" in this populations, adding that “clinical trials should evaluate the efficacy of duvalumab or targeted therapies in those with a targetable driver alteration.”

Source:

Cortiula F, De Ruysscher D, Steens M, et al. Adjuvant durvalumab after concurrent chemoradiotherapy for patients with unresectable stage III NSCLC harbouring uncommon genomic alterations. Eur J Cancer. 2023;184:172-178. doi:10.1016/j.ejca.2023.02.013