OBJECTIVES: For patients with unresectable LA-NSCLC who successfully complete definitive concurrent chemoradiotherapy (cCRT), durvalumab is the only consolidation treatment recommended by national clinical practice guidelines. Other non-approved agents are also used, but data on comparative clinical efficacy are limited. This study evaluated the comparative clinical efficacy of consolidation therapies after cCRT.

METHODS: MEDLINE, CENTRAL and Embase databases were systematically searched to identify phase III randomized controlled trials (RCTs) including cCRT with/without consolidation treatment for LA-NSCLC. Trials with progression-free survival (PFS) data were incorporated into a fixed-effects, proportional hazards Bayesian network meta-analysis. Only PFS outcomes were examined.

RESULTS: Of 4,752 records screened, 9 phase III trials met the eligibility criteria for this review, of which only 4 provided sufficient data after cCRT completion for direct incorporation into the meta-analysis (category-1). The remaining 5 trials did not report outcome measures after cCRT completion (category-2), limiting comparisons with other studies. Among category-1 studies, durvalumab demonstrated superior efficacy for PFS relative to each comparator including no consolidation therapy (hazard ratio [HR] 0.49 [95% credible interval (CrI): 0.41-0.56]; HR 0.52 [95% CI 0.42-0.65] from original PACIFIC trial), docetaxel (HR 0.42 [95% CrI: 0.28-0.63]), paclitaxel (HR 0.28 [95% CrI: 0.18-0.43]) and vinorelbine + cisplatin (HR 0.48 [95% CrI: 0.34-0.70]) administered in a consolidation setting. Further, paclitaxel demonstrated poorer PFS relative to no consolidation therapy (HR 1.74 [95% CrI: 1.15-2.62]). Important limitations included moderate between-trial heterogeneity, and small numbers of RCTs with varying quality and sample sizes.

CONCLUSIONS: In this network meta-analysis, durvalumab demonstrated superior efficacy for PFS relative to comparable consolidation therapies, or no consolidation therapy, for patients with unresectable LA-NSCLC, while paclitaxel demonstrated evidence of shortening PFS in this treatment setting. Additional analyses are warranted to incorporate category-2 RCTs using more sophisticated hazard functions and to assess overall survival, safety and other relevant outcome data.