Impact of durvalumab treatment duration on survival and healthcare utilization after chemoradiation for lung cancer: A real-world analysis.

Abstract

e20094 Background: Although durvalumab consolidation after chemoradiation improves survival in lung cancer, the ideal duration of therapy in real-world practice is not well defined. We evaluated clinical outcomes among patients receiving shorter compared with longer courses of durvalumab following chemoradiation. Methods: We conducted a retrospective cohort study using the TriNetX U.S. Collaborative Network, including patients with lung cancer who received concurrent chemoradiation followed by durvalumab consolidation. Patients were categorized based on duration of durvalumab therapy into a FULL cohort, defined as continued treatment for at least 12 months, and a SHORT cohort, defined as earlier discontinuation. Propensity score matching was applied to balance baseline demographic and clinical characteristics. Outcomes of interest included overall survival, hospital admission, critical care utilization, palliative care, emergency care, and prolonged services. Kaplan–Meier survival and risk-based analyses were performed. Results: After propensity score matching, 567 patients were included in each cohort with well-balanced baseline characteristics. Mortality was significantly lower in the FULL cohort compared with the SHORT cohort (28.1% vs 37.4%; risk difference −9.3%, p = 0.001). Patients in the FULL cohort experienced significantly improved overall survival (HR 0.66; 95% CI 0.54–0.81; log-rank p < 0.001), with longer median survival (1795 vs 1292 days). In addition, prolonged services utilization was lower in the FULL cohort (4.4% vs 9.2%; RR 0.48, p = 0.001), along with reduced risk of critical care exposure (HR 0.73; p = 0.012). No significant differences were observed in hospital admissions or emergency department visits. Conclusions: In this large real-world analysis, longer duration of durvalumab following chemoradiation was associated with improved survival and reduced high-intensity healthcare utilization. These findings support the importance of maintaining durvalumab therapy when feasible and underscore the need for strategies to optimize treatment adherence in clinical practice.