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Lung: Stage III NSCLC - adjuvant durvalumab

Free question published 11 August 2026

RespiratoryStage III NSCLC - adjuvant durvalumab

A 64-year-old man with unresectable stage IIIB (T3N2M0) NSCLC completes concurrent platinum-based chemoradiotherapy (60 Gy in 30 fractions with cisplatin-vinorelbine). Restaging CT four weeks later shows no progression and partial response. His PD-L1 tumour proportion score is 30% and there is no EGFR mutation or ALK rearrangement. WHO performance status is 1. What is the most appropriate next step?

  1. AConsolidation durvalumab for up to 12 months
  2. BAdjuvant platinum-doublet chemotherapy for four cycles
  3. CProphylactic cranial irradiation
  4. DSurveillance with no further anti-cancer treatment
  5. EPembrolizumab monotherapy until progression

Why A is correct

The PACIFIC trial randomised patients with unresectable stage III NSCLC whose disease had not progressed after platinum-based concurrent chemoradiotherapy to consolidation durvalumab for up to 12 months, demonstrating a sustained overall survival benefit (median OS 47.5 versus 29.1 months; HR 0.72). Consolidation durvalumab is now the standard of care in this setting for patients without progression.

And why the others are not

  • BAdditional platinum-doublet chemotherapy after concurrent chemoradiotherapy is not an evidence-based consolidation strategy and adds toxicity without benefit.
  • CProphylactic cranial irradiation is a small-cell lung cancer intervention, not part of stage III NSCLC management.
  • DSurveillance alone forgoes the proven survival benefit of consolidation durvalumab demonstrated in PACIFIC.
  • EPembrolizumab monotherapy until progression is a first-line metastatic regimen; the licensed consolidation agent after chemoradiotherapy in stage III is durvalumab for up to 12 months.

Source PACIFIC - Durvalumab after chemoradiotherapy in unresectable stage III NSCLC (5-year outcomes) — Spigel DR, Faivre-Finn C, Gray JE, et al. Five-Year Survival Outcomes From the PACIFIC Trial: Durvalumab After Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. J Clin Oncol. 2022;40(12):1301-1311.

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