Integrating Durvalumab with Neoadjuvant Chemoradiation and Surgery in Patients with Borderline Resectable Stage III Non-Small Cell Lung Cancer: A Retrospective Case Series

Background: Borderline resectable stage III non-small cell lung cancer (NSCLC) poses significant clinical challenges. This study evaluated the outcomes of patients receiving neoadjuvant chemoradiation (NA-CRT), durvalumab, and surgery. Materials and Methods A retrospective analysis of an institutional database identified patients with borderline resectable stage III NSCLC treated with NA-CRT, durvalumab, and completion surgery. The data collected included radiographic and pathologic responses, surgical and clinical outcomes, and adverse events (AEs). Results Between 2017 and2021, 11 patients received NA-CRT, durvalumab, and completion surgery. Patients received a median number of 6 durvalumab treatments. Preoperative imaging revealed partial response (n = 5) or stable disease (n = 6). Surgical procedures included lobectomy (n = 10) or pneumonectomy (n = 1), resulting in R0 resection in all patients. Eight patients (73%) had a pathologic complete response (pCR), and 9 (82%) had a major pathologic response (MPR). At a median follow-up of 27 months, two cases of metastatic recurrence occurred. The median, 1-year, and 2-year estimates of progression-free survival (PFS) and overall survival (OS) were: 23 months and 25 months, 82% and 100%, and 72% and 80% respectively. Univariate analysis revealed no factors associated with pCR, MPR, PFS, or OS. Six patients had immune-related AEs (irAEs), 6 had postoperative AEs, and none were grade 4 or 5. Conclusion This integrated approach of NA - CRT + durvalumab exhibited promising outcomes and tolerability in patients with borderline resectable stage III NSCLC. These results suggest a rationale for including radiation therapy in future trials examining neoadjuvant strategies for resectable NSCLC patients.