{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:46:56Z","timestamp":1784544416362,"version":"3.55.0"},"reference-count":74,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Introduction and Aim: Stage III Non-Small Cell Lung Cancer (NSCLC) has a poor prognosis, with median survival ranging from 9 to 34 months. The PACIFIC trial demonstrated that durvalumab after platinum-based chemoradiotherapy (CRT) improves overall survival (OS) and progression-free survival (PFS). This review evaluates real-world evidence (RWE) on durvalumab\u2019s efficacy and safety, focusing on patient characteristics, prognostic factors, treatment protocols, and outcomes beyond progression. Materials and Methods: A literature search of PubMed, Embase, and Google Scholar identified 49 observational studies published from January 2017 to August 2024 on unresectable stage III NSCLC. Clinical trials, early-stage disease, and alternative treatments were excluded. Results: Compared to the PACIFIC trial, real-world patients were older, had poorer ECOG performance (\u22652), and more comorbidities like COPD. Despite this, durvalumab provided consistent survival benefits. Positive prognostic factors included non-squamous histology, high PD-L1 expression, and timely durvalumab initiation (\u226442 days post-CRT). Most radiotherapy regimens mirrored PACIFIC (54\u201366 Gy). Concomitant CRT was used in 90% of cases, with sequential CRT for frail patients. Chemotherapy regimens varied. Immune-mediated pneumonitis was a major adverse event, with incidence rates between 15% and 100%. Severe cases led to treatment discontinuation, impacting survival. Treatment beyond progression remains uncertain, with limited benefits from immunotherapy rechallenge. Conclusions: RWE supports durvalumab\u2019s efficacy, emphasizing the need for personalized treatment strategies and further research to improve long-term outcomes.<\/jats:p>","DOI":"10.3390\/cancers17050874","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T05:41:51Z","timestamp":1741066911000},"page":"874","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Real-World Insights into the Impact of Durvalumab on Stage III Unresectable Non-Small Cell Lung Cancer\u2014A Narrative Review"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4555-1725","authenticated-orcid":false,"given":"Giorgio","family":"Facheris","sequence":"first","affiliation":[{"name":"Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Cossali","sequence":"additional","affiliation":[{"name":"Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Imbrescia","sequence":"additional","affiliation":[{"name":"Radiation Oncology Unit, Department of Oncology and Hematology, University Hospital of Modena, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0137-5142","authenticated-orcid":false,"given":"Salvatore","family":"La Mattina","sequence":"additional","affiliation":[{"name":"Departement of Radiation Oncology, San Matteo Hospital Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eneida","family":"Mataj","sequence":"additional","affiliation":[{"name":"Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Meli","sequence":"additional","affiliation":[{"name":"Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Volpi","sequence":"additional","affiliation":[{"name":"Azienda Ospedaliera Universitaria Integrata Verona, Radiation Oncology, 37126 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0168-3432","authenticated-orcid":false,"given":"Luca","family":"Triggiani","sequence":"additional","affiliation":[{"name":"Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Emanuele","family":"Guerini","sequence":"additional","affiliation":[{"name":"Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7163-2270","authenticated-orcid":false,"given":"Guido","family":"Levi","sequence":"additional","affiliation":[{"name":"Pulmonology Department, ASST Spedali Civili di Brescia, 25123 Brescia, Italy"},{"name":"Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6922-1934","authenticated-orcid":false,"given":"Salvatore","family":"Grisanti","sequence":"additional","affiliation":[{"name":"Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health Medical, ASST-Spedali Civili, University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5485-1260","authenticated-orcid":false,"given":"Michela","family":"Buglione di Monale e Bastia","sequence":"additional","affiliation":[{"name":"Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7275-7908","authenticated-orcid":false,"given":"Paolo","family":"Borghetti","sequence":"additional","affiliation":[{"name":"Radiation Oncology Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"506","DOI":"10.21037\/tlcr.2020.03.40","article-title":"Epidemiology of stage III lung cancer: Frequency, diagnostic characteristics, and survival","volume":"10","year":"2021","journal-title":"Transl. 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