How does pulmonary function impact QoL in patients with locally advanced NSCLC treated with chemoradiotherapy and durvalumab?

Background: Impaired pulmonary function is common among patients with lung cancer and may negatively affect health-related quality of life (HRQoL). The primary objective of the present sub-study of the DART-trial was to assess the overall quality of life changes during treatment and stratified by the presence of Chronic Obstructive Pulmonary Disease (COPD). Methods: The investigator-initiated DART trial (NCT04392505) included patients with unresectable stage III non-small cell lung cancer (NSCLC) treated with chemoradiotherapy followed by durvalumab. Baseline pulmonary function was measured by spirometry, and patients were stratified by FEV1/FVC <70% (COPD) or ≥70% (non-COPD). HRQoL was assessed regularly using the EORTC QLQ-C30 and QLQ-LC13 questionnaires at screening and during treatment. A difference in mean score of ≥10 was defined as clinically significant. Results: A total of 86 patients initiated durvalumab and completed at least one HRQoL assessment; pulmonary function data were available for 64 patients. For the overall cohort, quality of life scores remained stable throughout treatment. Patients with COPD consistently reported lower global health scores than those with preserved lung function. The global health score among patients with COPD was not significantly different at end of treatment compared to baseline, however significantly lower than patients without COPD. Symptom trajectories across QLQ-C30 scales were stable in both groups. Dyspnoea was more prevalent among patients with COPD. In the LC13 module, no clinically significant differences were observed except for dyspnoea, which was consistently higher among patients with COPD. Interpretation: The HRQoL remained stable during chemoradiotherapy and durvalumab treatment in stage III NSCLC patients. Impaired lung function was associated with modestly lower HRQoL, though larger studies are needed to confirm subgroup effects.