Functional decline at progression after durvalumab in stage III non-small cell lung cancer: prognostic impact and treatment patterns in a multicenter retrospective cohort study
Year: 2026
Type: article
Abstract: Background: Disease progression after durvalumab consolidation is frequent in unresectable stage III non-small cell lung cancer (NSCLC), but the prognostic relevance of functional and nutritional status at first progression is insufficiently characterized. We evaluated their associations with post-progression overall survival (OS) and receipt of subsequent systemic therapy. Methods: This five-center retrospective cohort study included patients with histologically confirmed unresectable stage III NSCLC who received definitive concurrent chemoradiotherapy (cCRT) followed by durvalumab and developed first documented disease progression. Clinical data were extracted using standardized case report forms. Eastern Cooperative Oncology Group (ECOG) performance status at progression, longitudinal body weight change from chemotherapy initiation to the last durvalumab administration, and post-progression treatment were evaluated. OS was calculated from first progression. The multivariable Cox model used complete cases; no imputation was performed. Results: 21.2 months; P=0.01). In the complete-case multivariable model (n=59; 33 deaths), ECOG ≥2 [hazard ratio (HR) 2.34, 95% confidence interval (CI): 1.12-4.89; P=0.02], body weight loss ≥3% (HR 2.37, 95% CI: 1.10-5.07; P=0.03), and progression within 6 months of durvalumab initiation (HR 2.16, 95% CI: 1.07-4.35; P=0.03) were associated with worse OS. Forty-seven patients (78.3%) received subsequent systemic therapy. Conclusions: At first progression after cCRT and durvalumab, impaired performance status was associated with poor post-progression survival. An exploratory, cohort-derived 3% weight-loss threshold and early progression also identified higher-risk patients but require external validation. Systematic functional and nutritional reassessment at progression may support individualized treatment planning, multidisciplinary supportive care, and realistic discussion of prognosis.
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223309594