Would you still consider durvalumab consolidation after definitive chemoradiation for patients with Stage III NSCLC who are on stable weekly methotrexate dosing for psoriasis/psoriatic arthritis?

I would. Given the (now) long-term follow up with the PACIFIC trial showing an approximately 10% improvement in 5-year survival from 33 to 43% (Spigel et al., ASCO 2021, abstract 8511), I believe the risk of psoriasis flare is acceptable. I would have a discussion ("shared decision") with the patient regarding the pros and cons of maintenance durvalumab and risk of psoriasis flare. While treatment of patients with pre-existing immune disorders was a real concern when checkpoint inhibitors were first introduced, there is now sufficient experience (largely retrospective) with these agents in this setting to support this application (Halle et al., PMID 34635495), with the expectation that approximately 50% will experience a flare, but probably...