Top Line: Should NSCLC patients who aren’t candidates for concurrent chemoradiation receive immunotherapy and radiation?
The Study: The standard treatment for inoperable, locally advanced NSCLC is concurrent chemoradiation followed by adjuvant durvalumab. However, there’s limited evidence to guide optimal treatment for those who aren’t good candidates for CRT. Sequential therapy can be considered or radiation alone using altered fractionation regimens. In this single arm, phase 2 trial, 58 patients with LA-NSCLC who were not candidates for CRT received conventionally fractionated radiation with concurrent and adjuvant durvalumab (think PACIFIC-2 minus chemotherapy). As expected, the population was older (median age 82 years) and more frail (only 7% ECOG 0) than the typical NSCLC population. The trial was designed to see if IO-RT could exceed a 2 year PFS of 36% compared to historical control of 20% with sequential chemo and RT. At 2 years PFS was 39% and OS was 54%. The rate of grade 3-4 adverse events was 21%, and 7% experienced grade 5 events. Better performance status and higher PD-L1 expression was associated with better survival outcomes.
TBL: This small phase 2 study showed encouraging outcomes with radiation and concurrent and adjuvant durvalumab for patients with LA-NSCLC who were not eligible for concurrent CRT. | Rimner, J Clin Oncol 2026
The Study: The standard treatment for inoperable, locally advanced NSCLC is concurrent chemoradiation followed by adjuvant durvalumab. However, there’s limited evidence to guide optimal treatment for those who aren’t good candidates for CRT. Sequential therapy can be considered or radiation alone using altered fractionation regimens. In this single arm, phase 2 trial, 58 patients with LA-NSCLC who were not candidates for CRT received conventionally fractionated radiation with concurrent and adjuvant durvalumab (think PACIFIC-2 minus chemotherapy). As expected, the population was older (median age 82 years) and more frail (only 7% ECOG 0) than the typical NSCLC population. The trial was designed to see if IO-RT could exceed a 2 year PFS of 36% compared to historical control of 20% with sequential chemo and RT. At 2 years PFS was 39% and OS was 54%. The rate of grade 3-4 adverse events was 21%, and 7% experienced grade 5 events. Better performance status and higher PD-L1 expression was associated with better survival outcomes.
TBL: This small phase 2 study showed encouraging outcomes with radiation and concurrent and adjuvant durvalumab for patients with LA-NSCLC who were not eligible for concurrent CRT. | Rimner, J Clin Oncol 2026