OBJECTIVES : Patients with unresectable stage III NSCLC are typically treated with CRT, followed by active surveillance and best standard-of-care. Prognosis is poor, with over 89% of patients progressing to metastatic disease. Various consolidation therapies have been tested but have limited efficacy. Durvalumab is the only approved consolidation treatment for patients whose disease has not progressed following concurrent platinum-based CRT. As overall survival (OS) and updated progression-free survival (PFS) data was recently published from the PACIFIC trial, we evaluated the comparative efficacy of consolidation therapy after CRT.

METHODS : We systematically searched MEDLINE®, Cochrane and Embase databases for phase III randomized controlled trials assessing NSCLC patients who received overlapping CRT, with and without subsequent consolidation treatment. Trials with PFS or OS data were incorporated into a fixed-effects, proportional hazards Bayesian NMA. Studies with sequential CRT weren’t included in this analysis.

RESULTS : We screened 5,140 records, identifying 4 trials which provided consolidation therapy after CRT. Durvalumab demonstrated statistically significant superiority for OS relative to standard-of-care (HR 0.68 [95% credible interval (CrI):0.55-0.87]), docetaxel (HR 0.61 [95% CrI:0.40-0.93]) and paclitaxel (HR 0.42, [95% CrI:0.26-0.69]) administered as consolidation therapy. Favorable OS outcomes for durvalumab relative to vinorelbine + cisplatin (HR: 0.70 [95% CrI:0.47-1.06]) weren’t statistically significant. Bayesian posterior probability of superiority for durvalumab was estimated to be 95.1% relative to vinorelbine + cisplatin, 98.9% relative to docetaxel and 100% relative to paclitaxel. Similar to previously reported PFS results, durvalumab remains significantly superior relative to all treatments for PFS: standard-of-care (HR 0.54, [95% CrI:0.44-0.67]), vinorelbine + cisplatin (HR 0.60 [95% CrI:0.41-0.87]), docetaxel (HR 0.53 [95% CrI:0.36-0.81]) and paclitaxel (HR 0.35 [95% CrI:0.21-0.53]).

CONCLUSIONS : In this NMA, durvalumab was the most favorable treatment for improving OS and PFS relative to no consolidation, or other assessed consolidation therapies. In contrast, consolidation paclitaxel was the least favorable of all assessed therapies.