Extensive-stage SCLC: durvalumab plus chemo extends survival in phase 3

  • Lancet

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Adding durvalumab to platinum-etoposide as first-line treatment for extended-stage small-cell lung cancer (ES-SCLC) significantly improved OS compared with platinum-etoposide alone.

Why this matters

  • The standard first-line treatment for ES-SCLC has been etoposide plus either cisplatin or carboplatin (platinum-etoposide), but most patients relapse within 6 months of treatment completion.
  • This trial is also exploring the efficacy of durvalumab plus tremelimumab plus platinum-etoposide vs platinum-etoposide alone, and those findings are forthcoming.

Study design

  • Interim analysis of the randomized, multicenter, international phase 3 CASPIAN trial.
  • Patients with ES-SCLC received frontline durvalumab plus platinum-etoposide (n=268) or platinum-etoposide alone (n=269).
  • Funding: AstraZeneca.

Key results

  • Median OS was significantly longer with durvalumab plus platinum-etoposide vs platinum-etoposide alone (13 vs 10.3 months; HR, 0.73; P=.0047), and was observed in all patient subgroups.
  • Post hoc OS was 54% with durvalumab vs 40% with platinum-etoposide alone at 12 months, and 34% vs 25% at 18 months.
  • Objective response rate was better with durvalumab vs platinum-etoposide alone (79% vs 70%; OR, 1.64; 95% CI, 1.11-2.44).
  • Immune-mediated events were more common with durvalumab (20% vs 3%); other adverse events were similar between groups.

Limitations

  • Open-label trial.