A New Standard of Care for Limited-Stage Small-Cell Lung Cancer?

Small-cell lung cancer (SCLC) is characterized by early progression and treatment resistance. Approximately one third of patients with SCLC are diagnosed with limited stage disease, for which the standard systemic therapy has not changed in decades.

In the industry-supported, phase 3 ADRIATIC trial, 730 patients who had completed chemoradiation for limited-stage SCLC were randomized to receive durvalumab (1500 mg), durvalumab plus tremelimumab, or placebo, every 4 weeks for up to 2 years. Eligible patients did not have progression after receipt of chemoradiation, had performance status of 0 or 1, and may have undergone prophylactic cranial radiation prior to randomization. The researchers report the first interim survival analysis comparing the durvalumab and placebo groups.

Estimated median overall survival (OS) was significantly longer in the durvalumab arm compared with the placebo arm (55.9 vs. 33.4 months; hazard ratio for death, 0.73). Median progression-free survival was also significantly longer in the durvalumab arm (16.6 vs. 9.2 months, respectively; HR for progression or death, 0.76). Rates of toxicity were similar in both arms. Grade 3 or 4 pneumonitis or radiation pneumonitis occurred in 3.1% of patients on durvalumab and 2.6% on placebo.