medwireNews: Adding durvalumab to first-line chemotherapy significantly improves the overall survival (OS) of patients with extensive-stage small-cell lung cancer (SCLC), a phase III trial shows.
As reported at the IASLC World Conference on Lung Cancer 2019 in Barcelona, Spain, the risk for death was a significant 27% lower for the patients who received the PD-L1 inhibitor together with etoposide and a platinum-based agent than for those given chemotherapy alone.
Speaking to the press, presenter Luis Paz-Ares (Hospital 12 de Octubre, Madrid, Spain) highlighted that this improvement was observed relative to “a robust control arm” that allowed patients to receive up to six cycles of etoposide–platinum.
“Of note, this chemo–immunotherapy regimen offers flexibility in platinum choice (carboplatin or cisplatin), reflecting current clinical practice for this challenging disease,” he added.
In the CASPIAN trial, median OS was 13.0 months for the 268 participants who were randomly assigned to receive durvalumab 1500 mg alongside etoposide–platinum every 3 weeks for four cycles, and was 10.3 months for their 269 counterparts who received up to six cycles of the chemotherapeutic regimen alone.
At the 12-month mark, the OS rates were 53.7% and 39.8% for the durvalumab and control arms, respectively, while the corresponding rates at 18 months were 33.9% and 24.7%.
Durvalumab addition was also associated with a significant 22% reduction in the risk for progression or death; the median progression-free survival (PFS) duration was 5.1 months for durvalumab-treated patients and 5.4 months for those given chemotherapy alone.
Commenting on the lower median PFS in the durvalumab arm, Paz-Ares told medwireNews that this discrepancy may be due to the longer course of treatment permitted in the control group.
“Indeed, if you look at the PFS curve, the separation starts after month 6, when patients had finished the sixth course of therapy in the chemotherapy arm,” he said.
The objective response rate was also higher with the addition of durvalumab to chemotherapy, at 67.9% versus 57.6% with chemotherapy alone, and a respective 22.7% and 6.3% of participants had an ongoing response at 12 months.
The incidence of all-cause grade 3 or 4 adverse events (AEs) and serious AEs was comparable in the durvalumab and control groups, at 61.5% versus 62.4% and 30.9% versus 36.1%, respectively, and the rate of discontinuation due to AEs was identical, at 9.4%.
Immune-related AEs were more common among durvalumab-treated participants than those given chemotherapy alone, at 19.6% and 2.6%, respectively, but that was as expected, Paz-Ares noted.
Five deaths in the durvalumab arm were attributed to treatment-related AEs, as were two deaths in the control arm.
Paz-Ares concluded: “Combining durvalumab with either cisplatin- or carboplatin-etoposide in [extensive-stage] SCLC provides an important new treatment option for patients and physicians.”
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