Concurrent chemoradiation with or without durvalumab in elderly patients with unresectable stage 3 non-small cell lung cancer: safety and efficacy

Abstract Background The addition of durvalumab after chemoradiation (CRT) in unresectable stage 3 non-small cell lung cancer (NSCLC) significantly improves survival. The benefit of this approach in elderly patients is controversial given the toxicity associated with CRT and thus may be underutilized. We sought to investigate the outcomes of elderly patients treated with CRT ±durvalumab at our center. Methods We reviewed all stage 3 NSCLC patients treated with CRT between 2018 and 2020. Patients were analyzed based on age: Results Of 115 patients (44 elderly/71 young), baseline characteristics including ECOG and comorbidities were similar. Completion rates of CRT (100%/97%) and chemotherapy dose intensity (97%/97%) were high in elderly/young patients, respectively. There was a trend towards increased hospitalizations in elderly patients due to infections (27% vs 13%; p=0.08). Of those who did not have primary progression after CRT, 78%/81% of elderly/young patients received durvalumab. The incidence of grade≥3 immune-related adverse events was 9%/6% in elderly/young patients; p=0.67. Median PFS was similar (15.6 vs 10.5 months; p=0.10), even after adjusting for comorbidities (HR 0.6; p=0.09). The 12-month OS rates were 78% in elderly and 76% in young patients (p=0.98). Conclusions Well selected elderly patients can be treated safely with CRT followed by durvalumab with similar survival benefits compared to their younger counterparts. We would advocate for the referral of all elderly patients for oncologic assessment to avoid under treatment.