Abstract

Background

Immune checkpoint inhibitors are increasingly being explored in the perioperative management of lung cancer; however, real-world evidence regarding postoperative outcomes and safety remains limited. We evaluated survival and immune-related adverse events associated with perioperative durvalumab use following lung cancer surgery.

Methods

We conducted a retrospective cohort study using data from 115 healthcare organizations participating in the TriNetX global research network, including adult patients (≥18 years) with lung cancer who underwent surgical resection. Patients were eligible if follow-up data were available for up to one year after surgery. The exposure cohort (Cohort 1: surgery plus durvalumab) consisted of patients who received durvalumab within six months before or after surgery, while the comparison cohort (Cohort 2: surgery alone) included patients who underwent surgery alone. Patients with a history of other primary malignancies, prior organ transplantation, receipt of alternative immune checkpoint inhibitors, or incomplete baseline or outcome data were excluded. Propensity score matching (1:1) was performed to balance demographics, comorbidities, laboratory values, and medication exposure. Outcomes were assessed from 1 to 365 days following the index surgery.

Results

At one-year, all-cause mortality was similar between the surgery plus durvalumab group and the surgery-only group (11.3% vs 13.7%; hazard ratio [HR] 0.85, 95% CI 0.42–1.72; log-rank p=0.65). One-year survival probabilities were comparable between groups (87.3% vs 85.4%). Composite immune-related adverse events, including pneumonitis, colitis, endocrine disorders, and hospitalization, occurred more frequently in the durvalumab group (47.6% vs 41.1%); however, this difference did not reach statistical significance (HR 1.20, 95% CI 0.83–1.75; p=0.10).

Conclusion

Perioperative durvalumab use in surgically treated lung cancer was not associated with increased one-year mortality. No statistically significant difference in immune-related or hospitalization outcomes was observed.

Clinical Implications

These findings provide real-world safety data regarding perioperative durvalumab use in surgically treated lung cancer, based on observed one-year mortality and immune-related and hospitalization outcomes. Well-designed controlled studies are needed to further evaluate the safety and clinical impact of perioperative durvalumab in this setting.

Biography

Mohammad Wateq Mohammad Albasuni is a medical student with strong academic interests in pulmonary and critical care medicine and clinical research. He has been involved in multiple research projects across several medical subjects and has contributed as a co-author to abstracts submitted to international conferences, including CHEST. Although he has not yet published formal research, he is actively developing his research skills and aims to pursue residency training in internal medicine. He is motivated to engage in research to advance evidence-based practice and improve patient care.