Real-World Insights into the Impact of Durvalumab on Stage III Unresectable Non-Small Cell Lung Cancer—A Narrative Review
Simple Summary
Abstract
1. Introduction
2. Materials and Methods
3. Results and Discussion
3.1. Patient Characteristics
3.2. Prognostic Factors
3.3. Chemo-Radiotherapy Regimen
3.4. Immune-Related Pneumonitis
3.5. PD-L1 and Driver Mutations
3.6. Treatment Beyond Progression
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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N° pts | Age, Median | Sex, Male (%) | Race | ECOG PS ≥ 2 (%) | Comorbidity | Smoking | Histology (%) | |
---|---|---|---|---|---|---|---|---|
Guberina et al. [6] | 39 | 62.3 | 67 | Missing | 8 | COPD G ≥ 3 5% | Ever smoker 95% | SCC 43.6 Non-SQ 56.4 |
Moore et al. [7] | 935 | 60 | 95 | White 78% Black 21% | 16 | CCI median: 6 pt COPD: 70% | Current 46% | SCC 50 Non-SQ 43 Other 7 |
Waterhouse et al. [8] | 528 | 70 | 51.5 | White 70.6% Black 5.5% Missing 23.9% | 9.1 | Missing | Current 23.5% Ever smoker79.6% | SCC 45.3 Non-SQ 44.7 Other 10 |
Huang et al. [9] | 39 | 64 | 79.5 | 97.4% Asiatic | 5.1 | Missing | Current 30.8% Ever smoker 79.5% | SCC 28.8 Non-SQ 61.1 Other 10.1 |
Preti et al. [10] | 118 | 66,3 | 51.7 | Missing | 0.7 | Missing | Current 24.7% Ever smoker 90.6% | SCC 32.2 Non-SQ 61.9 Other 5.9 |
Sankar et al. [11] | 1006 | 69 | Missing | White 74.1% African American 22% Other/unknown 3.9% | Missing | CCI G ≥ 6 51.3% | Current 43.2% Ever smoker 83.2% | SCC 48.2 Non-SQ 48.7 Other 3.1 |
Verschueren et al. [12] | 106 | 64.2 | 50.9 | Missing | 0.9 | Missing | Missing | SCC 30.8 Non-SQ 60.8 Other 8.4 |
Saad et al. [13] | 71 | 67 | 63.7 | Missing | 5.6 | Missing | Ever smoker 90.1% | SCC 32.4 Non-SQ 54.9 Other 12.7 |
Borghetti et al. [14] | 85 | 69 | 75 | Missing | 0 | COPD 57.1% COPD G ≥ 3 13.5% | Current 42.3% Ever smoker 92.3% | SCC 40.4 Non-SQ 55.8 Other 3.8 |
Avrillon et al. [15] | 576 | 64 | 72.9 | Missing | Missing | COPD 3.7% | Missing | SCC 39.9 Non-SQ 52.1 Other 8 |
Denault et al. [16] | 134 | 66 | 59.7 | Asian 8.2% Non Asian 91.8% | Missing | Missing | Missing | SCC 28.3 Non-SQ 70.1 Other 1.6 |
Girard et al. [17] | 1399 | 66 | 67.5 | Missing | 2 | Missing | Current 32.6% Ever smoker 92.1% | SCC 36 Non-SQ 64 |
Park et al. [18] | 157 | 65 | 85.4 | Missing | 10.8 | Comorbidity 72.6% COPD 31.8% | Current 32.5% Ever smoker 80.3% | SCC 52.2 Non-SQ 40.8 Other 7 |
Takeda et al. [19] | 107 | 70 | 76 | Missing | 0 | Missing | Missing | SCC 50 Non-SQ 43.9 Other 6.1 |
Gomez Rueda et al. [20] | 244 | 67 | 79.9 | Missing | 3.6 | COPD 23.8% Other Cancers 23.4% | Current 63.5% Former 33.2% | SCC 45.3 Non SQ 54.7 |
Stevens et al. [21] | 152 | 67 | 63.2 | Missing | 4.6 | COPD 32.9% Cardiovascular disease 56.6% | Current 67.7% Former 28% | SCC 32.2 Non SQ 57.2 |
Kakiuchi et al. [22] | 208 | 69.5 | 80.3 | Missing | 1 | Missing | Ever smoker 84.6% | SCC 40.9% Non-SQ 59.1 |
Trinh et al. [23] | 79 | 63.5 | 43 | Missing | Missing | Missing | Current 26.6% Former 68.4% | SCC 45.6% Non-SQ 48.1% Other 6.3% |
First Author | Year | Type of Article | Number of Patients | cCHT | sCHT | I Drug Carbo Platin | I Drug Cis Platin | II Drug Paclitaxel | II Drug Etoposide | II Drug Pemetrexed | II Drug Vinorelbina | Mono-CHT CBDCA | CHT 3-Week | CHT 1-Week | Dose < 54 Gy | Dose 54–66 Gy | Dose > 66 Gy | Dose 73.8 BIG | Dose 74 Gy | nFR | hFR | 3D | IMRT | VMAT | IMRT SS | Median OS | 1-Year OS | 2-Years OS | 3-Years OS |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
% | % | % | % | % | % | % | % | % | % | % | % | % | % | % | % | % | % | % | % | % | % | months | % | % | % | ||||
Riudavets et al. [30] | 2022 | Retrospective | 323 | 81 | 19 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 47 | - | - | - |
Gao et al. [31] | 2022 | Retrospective | 190 | 87.3 | 12.6 | 83.7 | 15.3 | 80 | 13.2 | 4.7 | 0 | 0 | - | - | - | 93.7 | 5.3 | - | - | - | - | - | - | - | - | - | 87 | - | 60.3 |
Pennock et al. [32] | 2023 | Retrospective | 59 | 100 | 0 | 100 | 0 | 100 | 0 | 0 | 0 | 0 | 0 | 100 | 11.8 | - | - | - | - | 68 | 32 | - | - | - | - | 32 | - | - | - |
Edwards et al. [33] | 2023 | Retrospective | 1994 | - | - | 71 | 0 | 71 | 0 | 0 | 0 | 0 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Wang et al. [34] | 2022 | Review | 1677 | 83.7 | 16.4 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 90 | - | - |
LeClair et al. [35] | 2021 | Retrospective | 83 | - | - | 78.4 | 17 | 70 | 9 | 14 | 0 | 0 | - | - | 85.5 | - | - | - | - | - | - | - | - | - | - | - | - | - | |
Shirasawa et al. [36] | 2021 | Retrospective | 551 | - | - | - | - | - | - | - | - | 13 | - | - | - | 100 | 5 | - | - | - | - | - | - | - | - | 51.8 | - | - | - |
Guo et al. [37] | 2022 | Retrospective | 134 | 100 | 0 | 78.4 | 21.5 | 54 | 10.9 | 35 | 0 | 0 | - | - | - | 100 | - | - | - | - | - | - | - | - | - | 32.4 | - | - | - |
Takeda et al. [19] | 2022 | Retrospective | 107 | 100 | 0 | 38.3 | 54.2 | 38.3 | 0 | 9.3 | 44.9 | 0 | - | 35.5 | - | 100 | - | - | - | - | - | 0 | 100 | 72.9 | 27.1 | - | 88 | 80 | 75 |
Abe et al. [38] | 2023 | Retrospective | 29 | 100 | 0 | - | - | - | - | - | - | - | - | - | - | 100 | - | - | - | - | - | 66 | - | 34.5 | 0 | - | 84 | - | - |
Storm et al. [39] | 2022 | Retrospective | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Girard et al. [17] | 2022 | Retrospective | 1399 | 76.6 | 14.4 | 37.3 | 51.2 | 27.6 | 20.4 | 10.7 | 33.1 | 0.5 | - | - | - | 41.4 | 52.4 | - | - | - | - | - | - | - | - | - | - | 71.2 | - |
Park et al. [18] | 2023 | Retrospective | 157 | 97.5 | 2.5 | 28 | 71.6 | 93 | 4.4 | - | 0.6 | - | 5.7 | 93 | 1.9 | 96.8 | 1.3 | - | - | - | - | 37 | 57.3 | - | - | - | 88 | 71 | 69.2 |
Li et al. [40] | 2023 | Review | 4496 | 93.2 | 6.8 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 87 | 48.1 | - |
Yamamoto et al. [41] | 2022 | Retrospective | 68 | - | - | 40 | 48 | 40 | - | - | 48 | - | - | - | - | 100 | - | - | - | 100 | 0 | 0 | 100 | 100 | 0 | - | 84 | - | - |
Taugner et al. [42] | 2021 | Prospective | 33 | 51.5 | 33.3 | - | 82 | - | - | - | 82 | - | - | - | - | 100 | - | - | - | 100 | 0 | 0 | 100 | 100 | 0 | - | 87 | - | - |
Qiu et al. [43] | 2023 | Retrospective | 353 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Sankar et al. [11] | 2022 | Retrospective | 1006 | 100 | 0 | 70.8 | 7.7 | 70.8 | 7.7 | 5.6 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 77 | 61.9 | - |
Wass et al. [29] | 2022 | Retrospective | 78 | 46.2 | 53.8 | 70.6 | 29.4 | 0 | 0 | 52.9 | 29.5 | 3.5 | - | - | - | 46.2 | - | 53.8 | - | - | - | 0 | 100 | 100 | 0 | - | - | - | - |
Park, Jeon et al. [44] | 2023 | Retrospective | 386 | 100 | 0 | 10.1 | 89.9 | 100 | 0 | 0 | 0 | 0 | 0 | 100 | - | - | - | - | - | - | - | - | - | - | - | - | - | 74.4 | - |
Moore et al. [7] | 2023 | Retrospective | 935 | 98 | 2 | 88 | 11 | - | - | - | - | - | - | - | 3 | 78 | 8 | - | 1 | - | - | - | - | - | - | - | - | - | - |
Guberina et al. [6] | 2022 | Retrospective | 160 | 96.9 | 3,1 | 5 | 78,1 | - | - | - | 81.2 | - | - | - | 0,6 | - | 5.6 | - | - | - | - | 0 | 100 | - | - | - | - | 80 | - |
Stana et al. [28] | 2023 | Retrospective | 112 | 0 | 100 | - | - | - | - | - | - | - | - | - | - | 50 | - | 50 | - | 50 | 50 | 0 | 100 | 54 | 46 | - | - | - | - |
Preti et al. [10] | 2023 | Retrospective | 118 | 100 | 0 | 50 | 44 | 33.8 | 27.11 | - | 0.8 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Lebow et al. [45] | 2023 | Retrospective | 81 | 100 | 0 | 69 | 29 | 38 | 7 | 53 | 0 | 0 | - | - | - | - | - | - | - | 100 | - | - | - | - | - | - | 93 | 72 | - |
Zhang et al. [24] | 2023 | Review | 4056 | 92 | 8 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 85 | - | - |
Denault et al. [16] | 2023 | Retrospective | 453 | - | - | 64.5 | 35.4 | - | - | - | - | - | - | - | - | 97.6 | - | - | - | - | - | - | - | - | - | 37.9 | - | 71.5 | - |
Spigel et al. [46] | 2022 | Prospective | 713 | 100 | 0 | 42.2 | 55.4 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 47.5 | 83 | 66.3 | 56.7 |
Borghetti, Volpi et al. [14] | 2023 | Retrospective | 85 | 87.1 | 12.9 | 82.3 | 3.5 | 82.3 | 3.5 | - | - | - | 52 | 48.2 | - | 100 | - | - | - | 100 | - | - | 100 | 94.1 | 5.9 | 52 | 83 | 69.4 | - |
Liu, Zhang et al. [47] | 2022 | Retrospective | 104 | 100 | 0 | 91 | 9 | 85 | 3 | 10 | 0 | 1 | - | - | - | 85 | 12 | - | - | - | - | - | - | - | - | 36.2 | - | - | |
Bryant et al. [25] | 2022 | Retrospective | 1306 | 100 | 0 | 71.6 | 8 | - | - | 2.9 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Liu, Bratton et al. [48] | 2022 | Retrospective | 5802 | 100 | 0 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Diamond et al. [49] | 2023 | Retrospective | 62 | 100 | 0 | 61 | - | 61 | - | - | - | - | - | - | - | 100 | - | - | - | - | - | 0 | 100 | - | - | - | 87 | - | - |
Hasegawa et al. [50] | 2023 | Retrospective | 127 | 98.4 | 1.6 | 41.7 | 41 | 41.7 | - | - | 13.4 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 18.2 | - | - | - |
Huang et al. [9] | 2022 | Retrospective | 84 | 100 | 0 | 28,6 | 63.1 | 26.2 | 38.1 | 27.4 | - | - | - | - | - | 100 | - | - | - | 100 | 0 | 0 | 100 | - | - | - | 94 | 75.2 | - |
Yang et al. [51] | 2023 | Review | 2560 | - | - | - | - | - | - | - | - | - | - | - | - | 100 | - | - | - | - | - | - | - | - | - | - | - | - | - |
Waterhouse et al. [8] | 2023 | Retrospective | 528 | 100 | 0 | 86.6 | 10.2 | 86.6 | 10.2 | - | - | - | - | - | 3,2 | 80.3 | - | - | - | - | - | - | - | - | - | - | 84 | 64 | - |
Verschueren et al. [12] | 2023 | Retrospective | 383 | 69.7 | 30.3 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 84 | - | - |
Saad et al. [13] | 2022 | Retrospective | 215 | 96 | 4 | 67.4 | 11.6 | 67.4 | 11.6 | - | - | - | - | - | - | 100 | - | - | - | - | - | 49 | 51.2 | - | - | - | 86 | - | - |
Avrillon et al. [15] | 2022 | Retrospective | 576 | 100 | 0 | 42.9 | 52.9 | 27.9 | 2.1 | 15.9 | 45 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Borghetti, Imbrescia et al. [52] | 2022 | Retrospective | 24 | 75 | 25 | 66.7 | 33 | 37.5 | 12.5 | 12.5 | 16.7 | 0 | 58 | 41.7 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - |
Boys et al. [53] | 2022 | Retrospective | 126 | 100 | 0 | 67 | 30 | 67 | 29 | 0.08 | - | - | - | - | 10 | 90 | - | - | - | 100 | 0 | 0 | 100 | - | - | 58.7 | - | - | - |
RT Technique | RT Dose (Median) | RT Dose Range | Lung V20 Median (%) | Lung V20, <30% (%) | Lung V20 ≥30% (%) | MLD Median (Gy) | MLD ≤18 Gy | MLD | MHD (Median) | MHD <10 Gy | MHD ≥10 Gy | N. of Cycles of Durvalumab (Median) | N. of Cycles of Durvalumab (Range) | Time to Durvalumab (Median, Days) | Time to Durvalumab (Range, Days) | Pneumonitis | G2+ Pneumonitis | G2+ Pneumonitis RT | G2+ Pneumonitis DURVA | G2+ Pneumonitis EQUIVOCAL | Grade 3+ Pneumonitis | Discontinued Durva Due to Pneumonitis | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Diamond et al. [49] | - | - | 60–64.8 | 27 | 56% | 44 | 15.5 | 77 | 23 | 9.50 Gy (6.25–14) | 55 | 45 | 17 | 8–24 | - | - | 42 | 32.30 | 24 | 6.50 | 1.6 | 9.7 | 11 |
Avrillon et al. [15] | - | - | 45–74 | - | - | - | - | - | - | - | - | - | 16 | 1–37 | 36 | 0–157 | - | - | - | - | - | - | - |
Huang et al. [9] | VMAT/IMRT | - | 60–66 | - | - | - | - | - | - | - | - | - | 13 | - | 38 | 28.2 | - | - | - | - | 7.7 | - | |
Waterhouse et al. [8] | - | - | 54–66 | - | - | - | - | - | - | - | - | - | - | - | 47 | 0–434 | - | - | - | 13.4 | - | - | - |
Saad et al. [13] | VMAT/IMRT | - | 56–66 | - | - | - | - | - | - | - | - | - | - | - | - | - | 49.3 | - | - | - | - | 5.6 | - |
Guberina et al. [6] | VMAT/IMRT | - | 53.5–74 | - | - | - | 15.2 | - | - | - | - | - | 18 | 1–27 | 25 | 7–80 | - | - | - | - | - | - | 10.25 |
Borghetti et al. [14] | VMAT/IMRT | 60 | - | - | - | - | - | - | - | - | - | - | - | - | 47 | 2–105 | 30.8 | 23.1 | - | - | - | 5.8 | 3.85 |
Preti et al. [10] | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 40.5 | 7–238 | 39.8 | 38.9 | 0 | 38.9 | 0 | 16.9 | - |
Stana et al. [28] | VMAT/IMRT | 72.3 | 39–88.2 | 20 | - | - | 12 | - | - | - | - | - | 15.6 | 15.6 | - | 2 | |||||||
Park et al. [18] | - | - | 54–66 | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 85.7 | - | - | - | - |
Wass et al (high dose arm) [29,43] | VMAT | 72 | - | 20.5 | - | - | 13 | - | - | - | - | - | 14 | 1–26 | 18.5 | 4–127 | 28.6 | - | - | - | - | - | - |
Wass et al (standard of care arm) [29] | VMAT | 59,4 | - | 16 | - | - | 16.7 | - | - | - | - | - | 8 | 1–21 | 22 | 2–114 | 27.8 | - | - | - | - | - | - |
Taugner et al. [42] | - | 63,6 | - | - | - | - | - | - | - | - | - | - | 14 | 2–24 | 25 | 13–103 | - | - | - | - | - | 15.38 | - |
Abe et al. [38] | VMAT/3D | 60 | - | 21.5 | - | - | 12.4 | - | - | 11.7 | - | - | 7 | - | - | - | 100 | 50 | - | - | - | 0 | 25 |
Park et al. [44] | VMAT/3D/IMRT | - | 54–66 | - | - | - | - | - | - | - | - | - | 19 | 1–32 | 32 | 0–86 | 36.6 | - | 36.3 | 14.6 | - | 1.9 | - |
LeClair et al. [35] | - | 60 | - | - | - | - | - | - | - | - | 13.9 | 1–47 | 57.3 | 8–226 | 25.3 | 22.9 | 2.4 | - | 6 | 22.9 | |||
Edwards et al. [33] | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 20.9 | - | 5.57 | 9 | 6.27 | - | - |
Gao et al. [31] | IMRT/IMPT | 60 | - | - | - | - | - | - | - | - | 12 | 4–22 | 35.5 | 27–52 | 26.3 | - | 7.4 | ||||||
Riudavets et al. [30] | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 21 | - | 4.6 | - |
Miura et al. [57] | - | 60 | 54–60 | 18.9 | - | - | - | - | - | - | - | - | - | - | 11 | 1–42 | 61 | 58.5 | - | - | - | 2.4 | 53.7 |
Inoue et al. [58] | 3D/IMRT/PRB | - | 60–64 | 22 | - | - | - | - | - | - | - | - | - | - | - | - | 73.3 | 46.7 | - | - | - | 0 | - |
Saito et al. [59] | 3D | - | - | - | - | - | - | - | - | - | - | - | - | 6.5 | 11 | 1–39 | - | - | - | - | - | - | 47.2 |
Jung et al. [60] | 3D/IMRT/PRB | - | - | - | - | - | - | - | - | - | - | - | - | - | - | - | 81 | 42.9 | - | - | - | 14.3 | 42.9 |
Mayahara et al. [61] | 3D/IMRT | 60 | 54–60 | - | - | - | - | - | - | - | - | - | - | - | - | - | 89.3 | 39.3 | - | - | - | 8.9 | 39.3 |
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Facheris, G.; Cossali, G.; Imbrescia, J.; La Mattina, S.; Mataj, E.; Meli, N.; Volpi, G.; Triggiani, L.; Guerini, A.E.; Levi, G.; et al. Real-World Insights into the Impact of Durvalumab on Stage III Unresectable Non-Small Cell Lung Cancer—A Narrative Review. Cancers 2025, 17, 874. https://doi.org/10.3390/cancers17050874
Facheris G, Cossali G, Imbrescia J, La Mattina S, Mataj E, Meli N, Volpi G, Triggiani L, Guerini AE, Levi G, et al. Real-World Insights into the Impact of Durvalumab on Stage III Unresectable Non-Small Cell Lung Cancer—A Narrative Review. Cancers. 2025; 17(5):874. https://doi.org/10.3390/cancers17050874
Chicago/Turabian StyleFacheris, Giorgio, Gianluca Cossali, Jessica Imbrescia, Salvatore La Mattina, Eneida Mataj, Nicole Meli, Giulia Volpi, Luca Triggiani, Andrea Emanuele Guerini, Guido Levi, and et al. 2025. "Real-World Insights into the Impact of Durvalumab on Stage III Unresectable Non-Small Cell Lung Cancer—A Narrative Review" Cancers 17, no. 5: 874. https://doi.org/10.3390/cancers17050874
APA StyleFacheris, G., Cossali, G., Imbrescia, J., La Mattina, S., Mataj, E., Meli, N., Volpi, G., Triggiani, L., Guerini, A. E., Levi, G., Grisanti, S., Buglione di Monale e Bastia, M., & Borghetti, P. (2025). Real-World Insights into the Impact of Durvalumab on Stage III Unresectable Non-Small Cell Lung Cancer—A Narrative Review. Cancers, 17(5), 874. https://doi.org/10.3390/cancers17050874