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Durvalumab and chemotherapy effective for extensive-stage small cell lung cancer

Rod Tucker
24 September, 2021  

Durvalumab and chemotherapy in extensive stage small cell lung cancer showed an improved overall survival compared to chemotherapy alone.

Small cell lung cancer (SCLC) is an aggressive high-grade neuroendocrine malignancy with a high metastatic potential and is associated with poor clinical outcomes.  Patients with extensive-stage small cell lung cancer (ES-SCLC) are normally treated with combination chemotherapy which includes carboplatin or cisplatin plus etoposide. In 2019 the CASPIAN study was published which compared combination chemotherapy, consisting of etoposide + cisplatin/carboplatin (EP), in treatment-naive patients with ES-SCLC with the addition of either durvalumab or tremelimumab. The results showed that addition of durvalumab (D + EP) led to a 27% reduction in the risk of death (Hazard ratio, HR = 0.73, 95% CI 0.59-0.91; p=0.0047) compared to chemotherapy alone. In a 2020 study update, the manufacturer, AstraZeneca, announced that after two years of follow-up, durvalumab (brand name Imfinzi), maintained a 25% reduction in the risk of death versus chemotherapy alone (HR of 0.75; 95% CI 0.62, 0.91; nominal p=0.0032). 

The latest results for the CASPIAN trial were presented at the ESMO 2021 conference. These show that after a median follow-up of 39.4 months, durvalumab and EP continued to maintain a 29% survival benefit (HR = 0.71, 95% CI 0.60–0.86; nominal p=0.0003) over chemotherapy. In terms of survival, 22.9% vs 13.9% of patients given durvalumab plus chemotherapy were alive at 24 months and 17.6% vs 5.8% of patients were alive at 36 months with D + EP vs EP.

The incidence of serious adverse events was broadly similar at 32.5%, and 36.5% for durvalumab and EP and EP alone respectively. Adverse events leading to death occurred 5.3%, and 6.0% (D +EP vs ES alone).

Given the overall survival benefit, the authors of the abstract concluded that their data further established D + EP as standard of care for the first-line treatment of ES-SCLC.

Source: AstraZeneca release 2021