Durvalumab Consolidation Extends Survival in LS-SCLC, ADRIATIC Findings Show

Missak Haigentz, MD

Significantly improved survival outcomes were observed with the administration of durvalumab (Imfinzi) as consolidation treatment after concurrent chemoradiation vs placebo in patients with limited-stage small cell lung cancer (LS-SCLC), according to findings from the ADRIATIC study (NCT03703297).¹

The median overall survival at a median follow-up of 37.2 months (range, 0.1-60.9) was 55.9 months (95% CI, 37.3-not evaluable) with durvalumab (n = 264) vs 33.4 months (95% CI, 25.5-39.9) with placebo (n = 266), translating to a 27% reduction in the risk of death (HR, 0.73; 95% CI, 0.57-0.93; P =.0104). At a median follow-up of 27.6 months (range, 0.0-55.8), the median progression-free survival was 16.6 months (95% CI, 10.2-28.2) with durvalumab compared with 9.2 months (95% CI, 7.4-12.9) with placebo. This translated to a 24% reduction in the risk of disease progression or death (HR, 0.76; 95% CI, 0.61-0.95; P =.0161).

In ADRIATIC, investigators sought to assess the role of durvalumab with or without tremelimumab (Imjudo) as consolidation therapy following concurrent chemoradiation in patients with LS-SCLC. Data from the study were presented at the 2024 American Society of Clinical Oncology Annual Meeting, and subgroup analyses were presented at the 2024 European Society for Medical Oncology Congress.

“This study demonstrated for the first time the role of durvalumab as a consolidative therapy for this unique group of patients by improving overall survival,” said Missak Haigentz, MD, in an interview with Targeted Oncology^TM.

In the interview, Haigentz, professor of medicine at Rutgers Robert Wood Johnson Medical School, chief of Thoracic and Head and Neck Medical Oncology at the Rutgers Cancer Institute, further discussed the implications and next steps of the ADRIATIC study.

Small cell lung cancer: © Констянтин Батыльчук- stock.adobe.com

Targeted Oncology: Can you provide an overview of the ADRIATIC trial?

Haigentz: ADRIATIC is a phase 3, global, randomized, placebo-controlled study of consolidative cancer immunotherapy following chemoradiotherapy for patients with limited-stage small cell lung cancer. This is a patient population for whom immunotherapy has not previously had a proven impact. So, this study demonstrated for the first time the role of durvalumab as a consolidative therapy for this unique group of patients by improving overall survival.

What are some of the unmet needs for patients with small cell lung cancer?

This has been a patient population for whom we have not seen advances in cancer care in decades, which has been a major challenge. We have made many advances for the care of our lung cancer patients on the whole and in other, specific subsets of non–small cell lung cancer. But for small cell lung cancer, the advances have been very limited. Immunotherapy had previously been FDA approved, PD-L1–based immunotherapy has been approved in the setting for patients with extensive-stage small cell lung cancer by improving survival outcomes, albeit less so than what we see for non–small cell lung cancer. But now we have the opportunity to impact our patients in a more curative intent treatment setting with consolidative immunotherapy.

Do you see the findings of ADRIATIC contributing to the treatment paradigms of this patient subset?

It is only the beginning. The impressive results of ADRIATIC demonstrated that the overall survival was able to demonstrate reduction in risk of mortality by 27%. There were 10% gains in 2-year and 3-year overall survival that coupled with progression-free survival. However, at 2 years, even with this new therapy, more than 50% of patients had already had disease progression Here, we are really heralding this advance.

This is only the beginning of being able to study novel immunotherapies and combination immunotherapies. The ADRIATIC [study] still has not read out its combination arm of durvalumab plus tremelimumab, and there are a whole number of other investigational studies that are seeking to improve on this.

Are there any other areas of research or agents that have been exciting and promising the field?

We had an FDA approval of a bispecific T-cell engager therapy, the first solid tumor bispecific T-cell engager, and that is FDA approved in small cell lung cancer. This provides a tremendous hope for our patients and the patient care community. This disease was once perceived as one that could not break a barrier [and] has now barriers [that] are being broken. We have a lot of hope. It is a tremendous victory for the patients as well as the providers.

REFERENCE:

Spigel DR, Cheng Y, Cho BC, et al. ADRIATIC: durvalumab (D) as consolidation treatment (tx) for patients (pts) with limited-stage small-cell lung cancer (LS-SCLC). J Clin Oncol. 2024;42(suppl 17):LBA5. doi:10.1200/JCO.2024.42.17_suppl.LBA5